Healthcare Provider Details

I. General information

NPI: 1942028634
Provider Name (Legal Business Name): CLINIVOY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2024
Last Update Date: 10/01/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3308 N HIGLEY RD STE 101
MESA AZ
85215-9781
US

IV. Provider business mailing address

16782 VON KARMAN AVE STE 12
IRVINE CA
92606-2417
US

V. Phone/Fax

Practice location:
  • Phone: 844-243-7833
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: GENEVIEVE BENJAMIN
Title or Position: CEO
Credential:
Phone: 949-783-7009