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General NPI Number Information
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NPI Number | 1669163937
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Entity Type | Organization
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Legal Business Name | SOTERIA WELLNESS CENTER LLC
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Dates
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Enumeration Date | 05/17/2023
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Last Update Date | 06/13/2023
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Provider Practice Location Address
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Address Line | 31048 N RANCHO TIERRA DR
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City | CAVE CREEK
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State | AZ
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Zip | 85331-5909
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Country | US
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Telephone | 508-904-2782
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Fax |
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Provider Business Mailing Address
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Address Line | 31048 N RANCHO TIERRA DR
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City | CAVE CREEK
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State | AZ
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Zip | 85331-5909
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Country | US
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Telephone | 508-904-2782
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | MISS ANISHA BUKENYA
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Credential |
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Telephone | 323-287-9324
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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