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General NPI Number Information
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NPI Number | 1255163382
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Entity Type | Organization
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Legal Business Name | AZ WELLNESS CLINICA FAMILIAR LLC
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Dates
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Enumeration Date | 08/16/2024
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Last Update Date | 08/16/2024
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Provider Practice Location Address
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Address Line | 10645 N 43RD AVE
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City | PHOENIX
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State | AZ
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Zip | 85029-3944
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Country | US
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Telephone | 602-370-2920
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Fax |
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Provider Business Mailing Address
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Address Line | 10645 N 43RD AVE
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City | PHOENIX
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State | AZ
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Zip | 85029-3944
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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 | MEDICAL DIRECTOR
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Name | JOSEPH GUTIERREZ
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Credential | MD
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Telephone | 480-433-9920
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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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