Provider Demographics
NPI:1164867099
Name:ARIZONA HEALTHY CLINIC LLC
Entity Type:Organization
Organization Name:ARIZONA HEALTHY CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:SUAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-594-2432
Mailing Address - Street 1:4344 WEST INDIAN SCHOOL ROAD
Mailing Address - Street 2:SUITE 8
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85031-2939
Mailing Address - Country:US
Mailing Address - Phone:623-954-2432
Mailing Address - Fax:623-594-2438
Practice Address - Street 1:4344 W INDIAN SCHOOL RD
Practice Address - Street 2:SUITE 8
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85031-2939
Practice Address - Country:US
Practice Address - Phone:623-954-2432
Practice Address - Fax:623-594-2438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-06
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty