Healthcare Provider Details

I. General information

NPI: 1023701976
Provider Name (Legal Business Name): VJUV CORPORATE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2023
Last Update Date: 06/12/2023
Certification Date: 06/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7233 E BASELINE RD STE 105
MESA AZ
85209-5001
US

IV. Provider business mailing address

3304 E MALDONADO DR
PHOENIX AZ
85042-6110
US

V. Phone/Fax

Practice location:
  • Phone: 480-593-5400
  • Fax: 602-626-8681
Mailing address:
  • Phone: 602-740-1331
  • Fax: 602-626-8681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number State

VIII. Authorized Official

Name: TINA FRENCH
Title or Position: OWNER
Credential:
Phone: 602-740-1331