Healthcare Provider Details

I. General information

NPI: 1295254472
Provider Name (Legal Business Name): HEALTHY LIFESTYLES CONSULTANTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2017
Last Update Date: 07/21/2022
Certification Date: 09/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3105 S 4TH AVE
YUMA AZ
85364-8122
US

IV. Provider business mailing address

3128 S BRAND LEE WAY
YUMA AZ
85365-5110
US

V. Phone/Fax

Practice location:
  • Phone: 702-481-8168
  • Fax:
Mailing address:
  • Phone: 702-481-8168
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number StateAZ
# 4
Primary TaxonomyY
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number StateAZ

VIII. Authorized Official

Name: JAMES GALAVIZ
Title or Position: OWNER/ THERAPIST
Credential: CMA LCMT
Phone: 702-481-8168