Healthcare Provider Details

I. General information

NPI: 1144894395
Provider Name (Legal Business Name): HEALING HANDS FAMILY PRACTICE AND AESTHETICS CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2021
Last Update Date: 08/05/2024
Certification Date: 08/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1141 E GLENDALE AVE STE 1094
PHOENIX AZ
85020-5316
US

IV. Provider business mailing address

1141 E GLENDALE AVE STE 1094
PHOENIX AZ
85020-5316
US

V. Phone/Fax

Practice location:
  • Phone: 832-818-6247
  • Fax:
Mailing address:
  • Phone: 832-818-6247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: ALVARO PINILLA
Title or Position: MEDICAL DIRECTOR
Credential:
Phone: 832-275-2224