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General NPI Number Information
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NPI Number | 1447864830
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Entity Type | Organization
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Legal Business Name | PREVENCARE HEALTH SERVICES, LLC
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Dates
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Enumeration Date | 09/02/2020
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Last Update Date | 09/02/2020
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Provider Practice Location Address
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Address Line | 750 BARTOW DR STE 16
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City | SIERRA VISTA
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State | AZ
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Zip | 85635-1833
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Country | US
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Telephone | 858-449-3798
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Fax |
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Provider Business Mailing Address
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Address Line | 1422 S APACHE DR
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City | CHANDLER
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State | AZ
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Zip | 85286-6300
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Country | US
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Telephone | 858-449-3798
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ERICK LEE
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Credential | ERICK LEE
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Telephone | 858-449-3798
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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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