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General NPI Number Information
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NPI Number | 1720220338
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Entity Type | Organization
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Legal Business Name | AGELESS HEALTH INSTITUTE, PC
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Dates
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Enumeration Date | 03/27/2009
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Last Update Date | 03/27/2009
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Provider Practice Location Address
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Address Line | 20616 N CAVE CREEK RD SUITE B110
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City | PHOENIX
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State | AZ
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Zip | 85024-4451
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Country | US
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Telephone | 888-461-4647
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Fax | 602-680-7857
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Provider Business Mailing Address
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Address Line | 18275 N 59TH AVE SUITE 162 BUILDING K
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City | GLENDALE
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State | AZ
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Zip | 85308-1260
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Country | US
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Telephone | 888-461-4647
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Fax | 602-680-7857
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. ERIC W HONING
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Credential | M.D.
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Telephone | 888-461-4647
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 29176
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License Number State | AZ
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