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General NPI Number Information
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NPI Number | 1164867099
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Entity Type | Organization
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Legal Business Name | ARIZONA HEALTHY CLINIC LLC
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Dates
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Enumeration Date | 05/06/2013
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Last Update Date | 02/18/2022
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Provider Practice Location Address
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Address Line | 4344 W INDIAN SCHOOL RD SUITE 8
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City | PHOENIX
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State | AZ
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Zip | 85031-2939
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Country | US
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Telephone | 623-954-2432
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Fax | 623-594-2438
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Provider Business Mailing Address
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Address Line | 4344 WEST INDIAN SCHOOL ROAD SUITE 8
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City | PHOENIX
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State | AZ
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Zip | 85031-2939
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Country | US
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Telephone | 623-954-2432
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Fax | 623-594-2438
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Authorized Official
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Title or Position | OWNER
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Name | DIANA SUAREZ
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Credential |
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Telephone | 623-594-2432
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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