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General NPI Number Information
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NPI Number | 1023355724
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Entity Type | Organization
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Legal Business Name | ARIZONA SYNERGY
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Dates
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Enumeration Date | 01/15/2013
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Last Update Date | 01/15/2013
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Provider Practice Location Address
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Address Line | 2573 S ARIZONA AVE SUITE D
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City | YUMA
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State | AZ
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Zip | 85364-7336
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Country | US
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Telephone | 928-750-5861
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Fax |
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Provider Business Mailing Address
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Address Line | 11801 N TATUM BLVD SUITE 124
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City | PHOENIX
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State | AZ
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Zip | 85028-1611
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Country | US
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Telephone | 928-750-5861
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Fax |
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Authorized Official
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Title or Position | DIRECTOR, INTEGRATED MEDICINE
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Name | MR. BRIAN PENNINGTON
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Credential |
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Telephone | 928-750-5861
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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