Healthcare Provider Details

I. General information

NPI: 1548994072
Provider Name (Legal Business Name): PRESTIGE VIRTUAL CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2022
Last Update Date: 05/01/2023
Certification Date: 05/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10830 N 71ST PL STE 105
SCOTTSDALE AZ
85254-6105
US

IV. Provider business mailing address

10830 N 71ST PL STE 105
SCOTTSDALE AZ
85254-6105
US

V. Phone/Fax

Practice location:
  • Phone: 480-206-5619
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: BRYAN EUGENE HOOPPAW
Title or Position: CEO
Credential:
Phone: 480-206-5619