Healthcare Provider Details

I. General information

NPI: 1952198483
Provider Name (Legal Business Name): STAY DRIPPED IV LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2025
Last Update Date: 04/21/2025
Certification Date: 04/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3007 N 73RD ST STE B
SCOTTSDALE AZ
85251-7203
US

IV. Provider business mailing address

3007 N 73RD ST STE B
SCOTTSDALE AZ
85251-7203
US

V. Phone/Fax

Practice location:
  • Phone: 480-826-3353
  • Fax:
Mailing address:
  • Phone: 480-826-3353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: DR. JABARI REEVES
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 510-333-4000