Healthcare Provider Details

I. General information

NPI: 1215634928
Provider Name (Legal Business Name): CHRISTIAN3 MEGA CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2023
Last Update Date: 09/08/2024
Certification Date: 09/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3707 E SOUTHERN AVE # 2704
MESA AZ
85206-2569
US

IV. Provider business mailing address

3707 E SOUTHERN AVE # 2704
MESA AZ
85206-2569
US

V. Phone/Fax

Practice location:
  • Phone: 661-383-3822
  • Fax:
Mailing address:
  • Phone: 661-383-3822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: MARGARET NSUBUGA KAYIIRA
Title or Position: CEO
Credential: RN
Phone: 661-383-3822