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General NPI Number Information
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NPI Number | 1508233693
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Entity Type | Organization
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Legal Business Name | YOUTHFUL LIVING LLC
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Dates
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Enumeration Date | 08/25/2015
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Last Update Date | 08/25/2015
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Provider Practice Location Address
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Address Line | 10222 W COGGINS DR
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City | SUN CITY
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State | AZ
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Zip | 85351-3407
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Country | US
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Telephone | 623-972-1840
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Fax | 623-972-1855
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Provider Business Mailing Address
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Address Line | PO BOX 12228
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City | GLENDALE
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State | AZ
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Zip | 85318-2228
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Country | US
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Telephone | 623-972-1840
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Fax | 623-972-1855
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Authorized Official
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Title or Position | OWNER/SOLE MEMBER
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Name | DR. ANGIE K HUXLEY
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Credential | DO
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Telephone | 623-972-1840
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 4547
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License Number State | AZ
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