Healthcare Provider Details

I. General information

NPI: 1154429694
Provider Name (Legal Business Name): SALUBRIOUS HEALTH CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5501 N 19TH AVE 218
PHOENIX AZ
85015-2450
US

IV. Provider business mailing address

5501 N 19TH AVE 218
PHOENIX AZ
85015-2450
US

V. Phone/Fax

Practice location:
  • Phone: 602-242-1221
  • Fax: 623-915-0280
Mailing address:
  • Phone: 602-242-1221
  • Fax: 623-915-0280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number3212
License Number StateAZ

VIII. Authorized Official

Name: SETH FOSTER EASLEY III
Title or Position: PRESIDENT
Credential: DO
Phone: 602-242-1221