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General NPI Number Information
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NPI Number | 1902348964
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Entity Type | Organization
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Legal Business Name | ENLIVEN MBS, LLC
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Dates
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Enumeration Date | 11/08/2016
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Last Update Date | 11/08/2016
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Provider Practice Location Address
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Address Line | 11000 N SCOTTSDALE RD STE 230
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City | SCOTTSDALE
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State | AZ
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Zip | 85254-6130
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Country | US
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Telephone | 347-470-9766
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Fax |
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Provider Business Mailing Address
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Address Line | 2108 S RURAL RD #24
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City | TEMPE
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State | AZ
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Zip | 85282-1420
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Country | US
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Telephone | 347-470-9766
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Fax |
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Authorized Official
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Title or Position | NATUROPATHIC MEDICAL DOCTOR
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Name | DR. VANESSA JANE FONTANILLA RUIZ
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Credential | NMD
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Telephone | 347-470-9766
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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 | 161567
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License Number State | AZ
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