Healthcare Provider Details

I. General information

NPI: 1477412831
Provider Name (Legal Business Name): VJUVINATE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2026
Last Update Date: 01/20/2026
Certification Date: 01/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 S POWER RD STE 108
MESA AZ
85206-5222
US

IV. Provider business mailing address

PO BOX 1377
HIGLEY AZ
85236-1377
US

V. Phone/Fax

Practice location:
  • Phone: 623-469-5889
  • Fax: 602-626-8681
Mailing address:
  • Phone: 623-469-5889
  • Fax: 602-626-8681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number
License Number State

VIII. Authorized Official

Name: JODIE SCHENK
Title or Position: OPERATIONS MANAGER
Credential:
Phone: 623-469-5889