MEDICARE: ARIZONA INTEGRATED MOBILE WELLNESS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency		AZ

General Provider Information

NPI Number	:	1083075311
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARIZONA INTEGRATED MOBILE WELLNESS LLC

Provider Business Mailing Address
First Line	:	8987 E. TANQUE VERDE RD
Second Line	:	SUITE 309-108
City	:	TUCSON
State	:	AZ
Zip	:	85749
Country	:	US
Telephone Number	:	520-906-1227
Fax Number	:

Provider Business Practice Location Address
First Line	:	8987 E TANQUE VERDE RD
Second Line	:	SUITE 308-108
City	:	TUCSON
State	:	AZ
Zip	:	85749-9610
Country	:	US
Telephone Number	:	520-906-1227
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. CYNTHIA LEA DOWDALL
Credential	:	PH.D.
Telephone Number	:	520-906-1227

Provider Enumeration Date	:	03/15/2016
Last Update Date	:	03/15/2016

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