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General NPI Number Information
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NPI Number | 1215354543
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Entity Type | Organization
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Legal Business Name | REGENESIS WELLNESS CENTER OF SCOTTSDALE
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Dates
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Enumeration Date | 03/25/2014
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Last Update Date | 12/13/2018
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Provider Practice Location Address
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Address Line | 9188 E SAN SALVADOR DR STE 201
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City | SCOTTSDALE
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State | AZ
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Zip | 85258-5534
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Country | US
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Telephone | 480-443-0004
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Fax | 480-391-7793
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Provider Business Mailing Address
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Address Line | 9188 E SAN SALVADOR DR STE 201
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City | SCOTTSDALE
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State | AZ
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Zip | 85258-5534
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DANETTE MITCHELL
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Credential |
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Telephone | 480-443-0004
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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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