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General NPI Number Information
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NPI Number | 1447865589
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Entity Type | Organization
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Legal Business Name | BEST LIFE MEDICAL LLC
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Dates
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Enumeration Date | 09/15/2020
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Last Update Date | 01/13/2025
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Provider Practice Location Address
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Address Line | 664 S JACOB ST
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City | GILBERT
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State | AZ
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Zip | 85296-2951
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Country | US
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Telephone | 480-359-3550
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Fax |
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Provider Business Mailing Address
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Address Line | 664 S JACOB ST
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City | GILBERT
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State | AZ
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Zip | 85296-2951
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Country | US
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Telephone | 602-708-6826
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Fax |
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Authorized Official
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Title or Position | OWNER / PRACTICE MANAGER
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Name | KELLY LUECK
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Credential |
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Telephone | 602-705-5072
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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