Provider Demographics
NPI:1093328767
Name:WHOLE HEALTH PRIMARY CARE LLC
Entity Type:Organization
Organization Name:WHOLE HEALTH PRIMARY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:OCTAVIA
Authorized Official - Middle Name:TERESE
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:619-600-9353
Mailing Address - Street 1:7113 W SOPHIE LN
Mailing Address - Street 2:
Mailing Address - City:LAVEEN
Mailing Address - State:AZ
Mailing Address - Zip Code:85339-3475
Mailing Address - Country:US
Mailing Address - Phone:619-600-9353
Mailing Address - Fax:
Practice Address - Street 1:7113 W SOPHIE LN
Practice Address - Street 2:
Practice Address - City:LAVEEN
Practice Address - State:AZ
Practice Address - Zip Code:85339-3475
Practice Address - Country:US
Practice Address - Phone:619-600-9353
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-24
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty