Healthcare Provider Details

I. General information

NPI: 1588299176
Provider Name (Legal Business Name): ARIZONA HEALTHY CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2020
Last Update Date: 03/04/2020
Certification Date: 03/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

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

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DIANA SUAREZ
Title or Position: OFFICE MANAGER
Credential: RMA
Phone: 623-594-2432