Provider Demographics
NPI:1083075311
Name:ARIZONA INTEGRATED MOBILE WELLNESS LLC
Entity Type:Organization
Organization Name:ARIZONA INTEGRATED MOBILE WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:LEA
Authorized Official - Last Name:DOWDALL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:520-906-1227
Mailing Address - Street 1:8987 E. TANQUE VERDE RD
Mailing Address - Street 2:SUITE 309-108
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85749
Mailing Address - Country:US
Mailing Address - Phone:520-906-1227
Mailing Address - Fax:
Practice Address - Street 1:8987 E TANQUE VERDE RD
Practice Address - Street 2:SUITE 308-108
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85749-9610
Practice Address - Country:US
Practice Address - Phone:520-906-1227
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-15
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health