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General NPI Number Information
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NPI Number | 1497360978
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Entity Type | Organization
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Legal Business Name | IOB WELLNESS CENTER LLC
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Dates
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Enumeration Date | 09/11/2020
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Last Update Date | 06/07/2021
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Provider Practice Location Address
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Address Line | 5060 N 19TH AVE # 406-9
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City | PHOENIX
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State | AZ
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Zip | 85015-3210
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Country | US
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Telephone | 623-777-0082
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Fax |
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Provider Business Mailing Address
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Address Line | 11114 W COLLEGE DR
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City | PHOENIX
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State | AZ
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Zip | 85037-1269
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Country | US
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Telephone | 623-777-0082
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ERIC NBIZI
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Credential |
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Telephone | 623-777-0082
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TR0400X
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Taxonomy Name | Rehabilitation Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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