Healthcare Provider Details

I. General information

NPI: 1205651833
Provider Name (Legal Business Name): INTEGRATED MEDICAL W CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2024
Last Update Date: 02/09/2026
Certification Date: 02/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6025 N 27TH AVE STE 5,6,7,8
PHOENIX AZ
85017-1764
US

IV. Provider business mailing address

6025 N 27TH AVE STE 5,6,7,8
PHOENIX AZ
85017-1763
US

V. Phone/Fax

Practice location:
  • Phone: 623-322-5992
  • Fax: 623-322-6151
Mailing address:
  • Phone: 623-322-5992
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: NORMA ARANDA
Title or Position: MEMBER/MANAGER
Credential:
Phone: 602-875-1721