Healthcare Provider Details

I. General information

NPI: 1144680455
Provider Name (Legal Business Name): SAN LUIS WALK-IN CLINIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/29/2016
Last Update Date: 09/07/2023
Certification Date: 09/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1233 N MAIN ST STE 1A
SAN LUIS AZ
85336-0663
US

IV. Provider business mailing address

PO BOX 617
SOMERTON AZ
85350-0617
US

V. Phone/Fax

Practice location:
  • Phone: 928-550-5514
  • Fax: 928-550-5160
Mailing address:
  • Phone: 928-315-7910
  • Fax: 928-722-6113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License NumberOTC7730
License Number StateAZ

VIII. Authorized Official

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