Healthcare Provider Details

I. General information

NPI: 1164867099
Provider Name (Legal Business Name): ARIZONA HEALTHY CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2013
Last Update Date: 02/18/2022
Certification Date: 02/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4344 W INDIAN SCHOOL RD SUITE 8
PHOENIX AZ
85031-2939
US

IV. Provider business mailing address

4344 WEST INDIAN SCHOOL ROAD SUITE 8
PHOENIX AZ
85031-2939
US

V. Phone/Fax

Practice location:
  • Phone: 623-954-2432
  • Fax: 623-594-2438
Mailing address:
  • Phone: 623-954-2432
  • Fax: 623-594-2438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DIANA SUAREZ
Title or Position: OWNER
Credential:
Phone: 623-594-2432