MEDICARE: WE CARE CLINIC 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	207Q00000X	Family Medicine Physician	116519	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306879689
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WE CARE CLINIC LLC

Provider Business Mailing Address
First Line	:	3620 W BETHANY HOME RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85019-1942
Country	:	US
Telephone Number	:	602-841-8273
Fax Number	:

Provider Business Practice Location Address
First Line	:	3620 W BETHANY HOME RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85019-1942
Country	:	US
Telephone Number	:	602-841-8273
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	OLENA KULAKOVA
Credential	:
Telephone Number	:	602-841-8273

Provider Enumeration Date	:	07/09/2006
Last Update Date	:	07/21/2022

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