Healthcare Provider Details

I. General information

NPI: 1417751637
Provider Name (Legal Business Name): RELATYV LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2025
Last Update Date: 05/01/2025
Certification Date: 05/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4140 E BASELINE RD STE 101
MESA AZ
85206-4413
US

IV. Provider business mailing address

4140 E BASELINE RD STE 101
MESA AZ
85206-4413
US

V. Phone/Fax

Practice location:
  • Phone: 832-683-5159
  • Fax: 877-285-0477
Mailing address:
  • Phone: 832-683-5159
  • Fax: 877-285-0477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name: JANICE COMPTON
Title or Position: CONTRACTING
Credential:
Phone: 830-832-9703