Healthcare Provider Details

I. General information

NPI: 1184354532
Provider Name (Legal Business Name): I AM WELLNESS AZ LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2022
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1616 E INDIAN SCHOOL RD STE 135
PHOENIX AZ
85016-8610
US

IV. Provider business mailing address

202 E EARLL DR STE 360
PHOENIX AZ
85012-2677
US

V. Phone/Fax

Practice location:
  • Phone: 480-900-9355
  • Fax:
Mailing address:
  • Phone: 601-324-0793
  • Fax: 480-779-1277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: THUY LINH NGUYEN
Title or Position: MANAGER
Credential:
Phone: 602-492-8606