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General NPI Number Information
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NPI Number | 1154645273
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Entity Type | Organization
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Legal Business Name | 5 MINUTE WALK-IN CLINIC LLC
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Dates
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Enumeration Date | 03/18/2010
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Last Update Date | 02/27/2020
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Provider Practice Location Address
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Address Line | 1962 E. JUAN SANCHEZ BLVD STE C-2
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City | SAN LUIS
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State | AZ
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Zip | 85349
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Country | US
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Telephone | 928-627-4963
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Fax | 928-627-9105
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Provider Business Mailing Address
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Address Line | 1962 E. JUAN SANCHEZ BLVD STE C-2
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City | SAN LUIS
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State | AZ
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Zip | 85349
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Country | US
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Telephone | 928-627-4963
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Fax | 928-627-9105
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Authorized Official
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Title or Position | OWNER
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Name | GILBERT VEGA
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Credential | PA-C
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Telephone | 928-503-4261
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 3434
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License Number State | AZ
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