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General NPI Number Information
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NPI Number | 1801592514
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Entity Type | Organization
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Legal Business Name | BEST LIFE WELLNESS AZ LLC
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Dates
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Enumeration Date | 02/03/2023
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Last Update Date | 02/03/2023
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Provider Practice Location Address
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Address Line | 14308 S VIA TRUJAL
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City | SAHUARITA
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State | AZ
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Zip | 85629-8465
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Country | US
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Telephone | 520-240-7121
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Fax |
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Provider Business Mailing Address
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Address Line | 1645 W VALENCIA RD # 109-217
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City | TUCSON
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State | AZ
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Zip | 85746-6040
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Country | US
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Telephone | 520-240-7121
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LISA L OLSON
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Credential | FNP-C
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Telephone | 520-240-7121
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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 |
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License Number State |
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