Provider Demographics
NPI:1093456105
Name:MY HEALTH FAMILY CLINIC AND MEDICAL SPA LLC
Entity Type:Organization
Organization Name:MY HEALTH FAMILY CLINIC AND MEDICAL SPA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IGNACIA
Authorized Official - Middle Name:ANDREA
Authorized Official - Last Name:QUIRINO
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:602-888-1916
Mailing Address - Street 1:7620 W THOMAS RD STE 104
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85033-5436
Mailing Address - Country:US
Mailing Address - Phone:602-888-1916
Mailing Address - Fax:602-584-3444
Practice Address - Street 1:7620 W THOMAS RD STE 104
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85033-5436
Practice Address - Country:US
Practice Address - Phone:602-888-1916
Practice Address - Fax:602-584-3433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ089270Medicaid