Healthcare Provider Details

I. General information

NPI: 1750550216
Provider Name (Legal Business Name): YUMA INFUSION THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2008
Last Update Date: 09/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2170 1/2 W 24TH ST
YUMA AZ
85364
US

IV. Provider business mailing address

1151 W IRON SPRINGS RD STE G
PRESCOTT AZ
86305-1614
US

V. Phone/Fax

Practice location:
  • Phone: 928-373-0101
  • Fax:
Mailing address:
  • Phone: 928-708-0025
  • Fax: 928-708-0288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License NumberY004865
License Number StateAZ

VIII. Authorized Official

Name: MR. PERLEY KEVIN NESTRICK
Title or Position: OWNER/CEO
Credential: RPH
Phone: 928-708-0025