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General NPI Number Information
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NPI Number | 1518836915
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Entity Type | Organization
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Legal Business Name | ABAN WELLNESS CARE
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Dates
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Enumeration Date | 11/03/2025
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Last Update Date | 11/03/2025
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Provider Practice Location Address
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Address Line | 2182 AZ - 95
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City | BULLHEAD CITY
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State | AZ
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Zip | 86442
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Country | US
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Telephone | 702-509-6667
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Fax |
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Provider Business Mailing Address
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Address Line | 2220 COUGAR DR APT 2049
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City | LAUGHLIN
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State | NV
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Zip | 89029-1282
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Country | US
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Telephone | 702-509-6667
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | GUILLERMO ZEGARRA
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Credential | MD
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Telephone | 702-509-6667
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207SG0201X
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Taxonomy Name | Clinical Genetics (M.D.) Physician
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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 | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number |
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License Number State |
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