Healthcare Provider Details

I. General information

NPI: 1114549987
Provider Name (Legal Business Name): SAN LUIS WALK-IN CLINIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2020
Last Update Date: 09/07/2023
Certification Date: 09/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 S OAK AVE STE 6
SAN LUIS AZ
85336-0756
US

IV. Provider business mailing address

PO BOX 617
SOMERTON AZ
85350-0617
US

V. Phone/Fax

Practice location:
  • Phone: 928-315-7910
  • Fax: 928-722-6113
Mailing address:
  • Phone: 928-315-7910
  • Fax: 928-722-6113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AMANDA AGUIRRE
Title or Position: PRESIDENT & CEO
Credential: RD
Phone: 928-315-7910