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NPI Code Detail

MEDICARE: NATURAL MEDICINE AND DETOX INC.

MEDICARE: NATURAL MEDICINE AND DETOX INC.
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
1261Q00000XClinic/Center0680AZ

General Provider Information

NPI Number : 1700253507
Entity Type Code : Organization
Provider Name (Legal Business Name) : NATURAL MEDICINE AND DETOX INC.
Provider Business Mailing Address
First Line : 2701 N 7TH ST
Second Line :
City : PHOENIX
State : AZ
Zip : 85006-1004
Country : US
Telephone Number : 602-307-0888
Fax Number : 602-307-1002
Provider Business Practice Location Address
First Line : 2701 N 7TH ST
Second Line :
City : PHOENIX
State : AZ
Zip : 85006-1004
Country : US
Telephone Number : 602-307-0888
Fax Number : 602-307-1002
Authorized Official
Title or Position : CLINIC DIRECTOR
Name : MR. MARIO FONTES
Credential : L.AC. CCH
Telephone Number : 602-307-0888
Provider Enumeration Date : 08/27/2015
Last Update Date : 11/04/2022

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Directions to “NATURAL MEDICINE AND DETOX INC. ” Practice Location

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