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General NPI Number Information
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NPI Number | 1760175723
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Entity Type | Organization
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Legal Business Name | INTEGRATED WELLNESS CENTER LLC
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Dates
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Enumeration Date | 05/26/2023
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Last Update Date | 05/30/2023
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Provider Practice Location Address
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Address Line | 2316 W NORTHERN AVE
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City | PHOENIX
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State | AZ
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Zip | 85021-4935
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Country | US
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Telephone | 602-838-7799
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Fax | 602-844-2525
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Provider Business Mailing Address
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Address Line | 5523 S JOLLY ROGER RD
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City | TEMPE
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State | AZ
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Zip | 85283-2118
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Country | US
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Telephone | 650-847-8861
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Fax | 602-844-2525
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | RAVIKULASINGHAM THURAISINGAM
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Credential |
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Telephone | 650-847-8861
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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