MEDICARE: VITAL HORMONES AND WEIGHT LOSS

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	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1184515249
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VITAL HORMONES AND WEIGHT LOSS

Provider Business Mailing Address
First Line	:	22591 S 225TH WAY
Second Line	:
City	:	QUEEN CREEK
State	:	AZ
Zip	:	85142-5678
Country	:	US
Telephone Number	:	480-318-1823
Fax Number	:

Provider Business Practice Location Address
First Line	:	21455 S ELLSWORTH RD
Second Line	:
City	:	QUEEN CREEK
State	:	AZ
Zip	:	85142-9849
Country	:	US
Telephone Number	:	480-318-1823
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PROVIDER
Name	:	JENNIFER HULS
Credential	:	FNP-BC
Telephone Number	:	480-318-1823

Provider Enumeration Date	:	07/15/2025
Last Update Date	:	12/18/2025

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