Healthcare Provider Details

I. General information

NPI: 1578440749
Provider Name (Legal Business Name): LOTUSHOLISTICHEALTHCARES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22424 S ELLSWORTH LOOP RD UNIT 104
QUEEN CREEK AZ
85142-7032
US

IV. Provider business mailing address

22424 S ELLSWORTH LOOP RD UNIT 104
QUEEN CREEK AZ
85142-7032
US

V. Phone/Fax

Practice location:
  • Phone: 602-860-6319
  • Fax:
Mailing address:
  • Phone: 602-707-6582
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: TITILAYO RAJI
Title or Position: CFO
Credential:
Phone: 602-707-6582