Healthcare Provider Details

I. General information

NPI: 1740462761
Provider Name (Legal Business Name): NATIVE HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2007
Last Update Date: 05/13/2025
Certification Date: 05/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4041 N CENTRAL AVE BLDG C
PHOENIX AZ
85012-3313
US

IV. Provider business mailing address

4041 N. CENTRAL AVE BUILDING C
PHOENIX AZ
85012-3313
US

V. Phone/Fax

Practice location:
  • Phone: 602-279-5262
  • Fax: 602-279-5390
Mailing address:
  • Phone: 602-279-5262
  • Fax: 602-279-5390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MR. WALTER MURILLO
Title or Position: CEO
Credential:
Phone: 602-279-5262