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General NPI Number Information
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NPI Number | 1912779646
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Entity Type | Individual
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Provider Name | FRANCIANE FONSECA GONCALVES REIS ND
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Gender | Female
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Dates
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Enumeration Date | 10/25/2023
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Last Update Date | 10/25/2023
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Provider Practice Location Address
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Address Line | 297 LAKE HAVASU AVE S STE 200
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City | LAKE HAVASU CITY
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State | AZ
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Zip | 86403-6526
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Country | US
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Telephone | 928-419-2627
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Fax |
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Provider Business Mailing Address
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Address Line | 3050 PALISADES DR
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City | LAKE HAVASU CITY
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State | AZ
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Zip | 86404-4509
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Country | US
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Telephone | 248-510-8734
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 23.1802
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License Number State | AZ
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