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General NPI Number Information
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NPI Number | 1730547282
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Entity Type | Organization
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Legal Business Name | SOLUNA HOLISTIC HEALTHCARE, INC.
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Dates
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Enumeration Date | 01/29/2016
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Last Update Date | 01/29/2016
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Provider Practice Location Address
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Address Line | 14122 W MCDOWELL RD SUITE 102-B
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City | GOODYEAR
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State | AZ
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Zip | 85395-2503
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Country | US
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Telephone | 623-693-3000
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Fax |
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Provider Business Mailing Address
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Address Line | 14122 W MCDOWELL RD SUITE 102-B
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City | GOODYEAR
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State | AZ
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Zip | 85395-2503
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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 | PRESIDENT
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Name | MS. SARAH MARIA LARSON
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Credential | ANP-C
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Telephone | 623-693-3000
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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 | AP4007
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License Number State | AZ
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