Healthcare Provider Details

I. General information

NPI: 1285588681
Provider Name (Legal Business Name): SOUTHWEST INTEGRATIVE GERIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2026
Last Update Date: 02/23/2026
Certification Date: 02/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1475 N SCOTTSDALE RD
SCOTTSDALE AZ
85257
US

IV. Provider business mailing address

18402 N 19TH AVE # 326
PHOENIX AZ
85023-1361
US

V. Phone/Fax

Practice location:
  • Phone: 203-632-9565
  • Fax:
Mailing address:
  • Phone: 203-632-9565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State

VIII. Authorized Official

Name: DR. JADE RILEY
Title or Position: PHYSICIAN
Credential:
Phone: 203-632-9565