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General NPI Number Information
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NPI Number | 1568782308
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Entity Type | Organization
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Legal Business Name | MEN'S VITALITY CENTER, PLLC
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Dates
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Enumeration Date | 06/03/2010
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Last Update Date | 06/03/2010
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Provider Practice Location Address
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Address Line | 4653 S LAKESHORE DR SUITE 2
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City | TEMPE
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State | AZ
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Zip | 85282-7161
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Country | US
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Telephone | 480-456-8981
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Fax |
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Provider Business Mailing Address
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Address Line | 12878 N 119TH ST
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City | SCOTTSDALE
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State | AZ
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Zip | 85259-2736
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/MBR
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Name | NIKKI MIGLORE
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Credential | DC
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Telephone | 480-229-1986
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 364SA2200X
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Taxonomy Name | Adult Health Clinical Nurse Specialist
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License Number |
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License Number State |
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