Healthcare Provider Details

I. General information

NPI: 1366564452
Provider Name (Legal Business Name): HEALTHSTYLES SOUTHWEST, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 04/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1432 E NORTHERN AVE
PHOENIX AZ
85020-4319
US

IV. Provider business mailing address

1432 E NORTHERN AVE
PHOENIX AZ
85020-4319
US

V. Phone/Fax

Practice location:
  • Phone: 602-944-9626
  • Fax: 602-216-7834
Mailing address:
  • Phone: 602-944-9626
  • Fax: 602-216-7834

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2471V0105X
TaxonomyVascular Sonography Radiologic Technologist
License Number
License Number State

VIII. Authorized Official

Name: IRENE D BRADT
Title or Position: PRESIDENT
Credential:
Phone: 602-944-9626