Healthcare Provider Details

I. General information

NPI: 1417327107
Provider Name (Legal Business Name): HEALOGICS SPECIALTY PHYSICIANS OF ARIZONA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2015
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2460 S PARKVIEW LOOP STE 205
YUMA AZ
85364-5358
US

IV. Provider business mailing address

5220 BELFORT RD STE 130
JACKSONVILLE FL
32256-6018
US

V. Phone/Fax

Practice location:
  • Phone: 928-336-2030
  • Fax:
Mailing address:
  • Phone: 904-446-3686
  • Fax: 904-446-3032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2083P0011X
TaxonomyUndersea and Hyperbaric Medicine (Preventive Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: PAMELA MANDEL
Title or Position: CEO
Credential:
Phone: 904-446-3686