Provider Demographics
NPI:1033547088
Name:ALETRIS CENTER OF INTEGRATIVE MEDICINE
Entity Type:Organization
Organization Name:ALETRIS CENTER OF INTEGRATIVE MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:TERLISNER
Authorized Official - Suffix:
Authorized Official - Credentials:NMD
Authorized Official - Phone:480-998-2020
Mailing Address - Street 1:7425 E SHEA BLVD STE 111
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-6411
Mailing Address - Country:US
Mailing Address - Phone:480-998-2020
Mailing Address - Fax:480-948-1367
Practice Address - Street 1:7425 E SHEA BLVD STE 111
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-6411
Practice Address - Country:US
Practice Address - Phone:480-998-2020
Practice Address - Fax:480-948-1367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-29
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ06-969208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ13-1402OtherNONE
AZ06-969OtherNONE
AZ09-1160OtherNONE
AZ8268OtherNONE