Healthcare Provider Details

I. General information

NPI: 1245118538
Provider Name (Legal Business Name): DIABETES NEUROPATHY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2025
Last Update Date: 10/08/2025
Certification Date: 10/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 WHIPPLE ST
PRESCOTT AZ
86301-1712
US

IV. Provider business mailing address

412 WHIPPLE ST
PRESCOTT AZ
86301-1712
US

V. Phone/Fax

Practice location:
  • Phone: 480-788-5621
  • Fax: 480-779-1277
Mailing address:
  • Phone: 480-788-5621
  • Fax: 480-779-1277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: THUY LINH NGUYEN
Title or Position: DIRECTOR
Credential:
Phone: 623-693-3400