MEDICARE: VJUVINATE 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	207VF0040X	Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician

General Provider Information

NPI Number	:	1477412831
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VJUVINATE LLC

Provider Business Mailing Address
First Line	:	PO BOX 1377
Second Line	:
City	:	HIGLEY
State	:	AZ
Zip	:	85236-1377
Country	:	US
Telephone Number	:	623-469-5889
Fax Number	:	602-626-8681

Provider Business Practice Location Address
First Line	:	801 S POWER RD STE 108
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85206-5222
Country	:	US
Telephone Number	:	623-469-5889
Fax Number	:	602-626-8681

Authorized Official
Title or Position	:	OPERATIONS MANAGER
Name	:	JODIE SCHENK
Credential	:
Telephone Number	:	623-469-5889

Provider Enumeration Date	:	01/20/2026
Last Update Date	:	01/20/2026

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Directions to “VJUVINATE LLC ” Practice Location

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