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General NPI Number Information
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NPI Number | 1841697091
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Entity Type | Organization
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Legal Business Name | THE ANTI-AGING SPOT LLC
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Dates
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Enumeration Date | 12/02/2014
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Last Update Date | 12/02/2014
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Provider Practice Location Address
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Address Line | 4845 E THUNDERBIRD RD STE 4
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City | SCOTTSDALE
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State | AZ
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Zip | 85254-3556
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Country | US
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Telephone | 480-599-8370
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Fax | 480-436-6747
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Provider Business Mailing Address
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Address Line | 1753 E BROADWAY RD STE 101-190
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City | TEMPE
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State | AZ
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Zip | 85282-1580
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Country | US
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Telephone | 602-321-7578
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. CARMEN MORA
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Credential | ND
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Telephone | 480-599-8370
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175F00000X
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Taxonomy Name | Naturopath
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License Number | 14-1470
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License Number State | AZ
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