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General NPI Number Information
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NPI Number | 1306879689
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Entity Type | Organization
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Legal Business Name | WE CARE CLINIC LLC
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Dates
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Enumeration Date | 07/09/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 3620 W BETHANY HOME RD
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City | PHOENIX
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State | AZ
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Zip | 85019-1942
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Country | US
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Telephone | 602-841-8273
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Fax |
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Provider Business Mailing Address
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Address Line | 3620 W BETHANY HOME RD
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City | PHOENIX
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State | AZ
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Zip | 85019-1942
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Country | US
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Telephone | 602-841-8273
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | OLENA KULAKOVA
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Credential |
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Telephone | 602-841-8273
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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 | 116519
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License Number State | AZ
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