Healthcare Provider Details

I. General information

NPI: 1306645627
Provider Name (Legal Business Name): IVAZ LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2025
Last Update Date: 03/10/2025
Certification Date: 03/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13-1263 LEILANI AVE
PAHOA HI
96778-8225
US

IV. Provider business mailing address

106 W OSBORN RD STE 1161
PHOENIX AZ
85013-3909
US

V. Phone/Fax

Practice location:
  • Phone: 808-315-1918
  • Fax: 307-333-0339
Mailing address:
  • Phone: 808-315-1918
  • Fax: 307-333-0339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM TEMPANY
Title or Position: CHIEF EXECUTIVE MANAGER
Credential:
Phone: 808-315-1918