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General NPI Number Information
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NPI Number | 1790633451
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Entity Type | Organization
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Legal Business Name | SHAKA MENTAL WELLNESS LLC
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Dates
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Enumeration Date | 03/18/2026
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Last Update Date | 03/18/2026
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Provider Practice Location Address
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Address Line | 6630 E CARONDELET DR
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City | TUCSON
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State | AZ
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Zip | 85710-2119
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Country | US
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Telephone | 520-343-3775
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Fax | 520-343-3775
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Provider Business Mailing Address
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Address Line | 6630 E CARONDELET DR
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City | TUCSON
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State | AZ
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Zip | 85710-2119
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Country | US
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Telephone | 520-343-3775
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Fax |
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Authorized Official
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Title or Position | DNP, PMHNP-BC
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Name | ALEXIS CATHLEEN LOPEZ
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Credential | DNP
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Telephone | 520-343-3775
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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