Healthcare Provider Details

I. General information

NPI: 1649426073
Provider Name (Legal Business Name): WELLCARE HEALTH INSURANCE OF ARIZONA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2008
Last Update Date: 05/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

949 KAMOKILA BLVD SUITE 350
KAPOLEI HI
96707
US

IV. Provider business mailing address

8735 HENDERSON RD
TAMPA FL
33634-1143
US

V. Phone/Fax

Practice location:
  • Phone: 808-675-7300
  • Fax: 813-283-9343
Mailing address:
  • Phone: 813-290-6200
  • Fax: 813-290-6210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL HABER
Title or Position: VP & SECRETARY
Credential:
Phone: 813-206-1490