1720284920 NPI number — WE CARE OSTEOPATHIC WELLNESS CENTER, P.C.

Table of content: (NPI 1720284920)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720284920 NPI number — WE CARE OSTEOPATHIC WELLNESS CENTER, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WE CARE OSTEOPATHIC WELLNESS CENTER, P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1720284920
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2730 S VAL VISTA DR
Provider Second Line Business Mailing Address:
SUITE 138 BLDG 7
Provider Business Mailing Address City Name:
GILBERT
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85296-6675
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-686-9686
Provider Business Mailing Address Fax Number:
480-686-9508

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2730 S VAL VISTA DR
Provider Second Line Business Practice Location Address:
SUITE 138 BLDG 7
Provider Business Practice Location Address City Name:
GILBERT
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85296-6675
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-686-9686
Provider Business Practice Location Address Fax Number:
480-686-9508
Provider Enumeration Date:
06/25/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ROSS
Authorized Official First Name:
JORDAN
Authorized Official Middle Name:
S
Authorized Official Title or Position:
RENDERING PROVIDER
Authorized Official Telephone Number:
480-686-9686

Provider Taxonomy Codes

  • Taxonomy code: 204D00000X , with the licence number:  3119 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 207Q00000X , with the licence number: 3119 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3119 . This is a "AZ LICENSE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com