Healthcare Provider Details

I. General information

NPI: 1598305757
Provider Name (Legal Business Name): MY MYO MY HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2020
Last Update Date: 01/15/2020
Certification Date: 01/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2155 W PINNACLE PEAK RD STE 201
PHOENIX AZ
85027-1203
US

IV. Provider business mailing address

2155 W PINNACLE PEAK RD STE 201
PHOENIX AZ
85027-1203
US

V. Phone/Fax

Practice location:
  • Phone: 602-699-5983
  • Fax: 480-471-8160
Mailing address:
  • Phone: 602-699-5983
  • Fax: 480-471-8160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BYRAN DAVID RUBIO
Title or Position: BUSINESS MANAGER
Credential:
Phone: 602-699-5983