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General NPI Number Information
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NPI Number | 1619633088
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Entity Type | Organization
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Legal Business Name | INNOVATIVE PRIMARY CARE OF HAVASU LLC
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Dates
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Enumeration Date | 11/10/2021
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Last Update Date | 11/10/2021
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Provider Practice Location Address
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Address Line | 1945 MESQUITE AVE STE B
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City | LAKE HAVASU CITY
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State | AZ
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Zip | 86403-5889
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Country | US
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Telephone | 928-733-6287
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Fax | 928-733-6305
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Provider Business Mailing Address
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Address Line | 1945 MESQUITE AVE STE B
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City | LAKE HAVASU CITY
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State | AZ
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Zip | 86403-5889
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Country | US
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Telephone | 928-733-6287
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Fax | 928-733-6305
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Authorized Official
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Title or Position | PRIMARY PROVIDER
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Name | LOIDA LOYOLA ARQUIZA
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Credential | NP
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Telephone | 240-535-0065
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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