Provider Demographics
NPI:1346459062
Name:COMPREHENSIVE MEDICINE AND NUTRITION, PC
Entity Type:Organization
Organization Name:COMPREHENSIVE MEDICINE AND NUTRITION, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CARA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDRUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-867-1302
Mailing Address - Street 1:23623 N SCOTTSDALE RD
Mailing Address - Street 2:SUITE D-3 #479
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-0152
Mailing Address - Country:US
Mailing Address - Phone:480-845-0352
Mailing Address - Fax:480-607-3808
Practice Address - Street 1:6027 E IRONWOOD DR
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85266-6734
Practice Address - Country:US
Practice Address - Phone:480-845-0352
Practice Address - Fax:480-607-3808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ36912207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ266216Medicaid