=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407472467
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEALTHY YOU
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/24/2020
-----------------------------------------------------
Last Update Date | 01/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1760 E PECOS RD STE 431
-----------------------------------------------------
City | GILBERT
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85295-3209
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-237-3451
-----------------------------------------------------
Fax | 480-499-5666
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1760 E PECOS RD STE 431
-----------------------------------------------------
City | GILBERT
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85295-3209
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 872-212-7966
-----------------------------------------------------
Fax | 480-499-5666
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PRESIDENT
-----------------------------------------------------
Name | OMAR L. DOMINIQUE
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 872-212-7966
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------