Provider Demographics
NPI:1609185917
Name:ANTI-AGING INSTITUTE OF ARIZONA, INC.
Entity Type:Organization
Organization Name:ANTI-AGING INSTITUTE OF ARIZONA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-292-1110
Mailing Address - Street 1:3514 N POWER RD STE 107
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85215-2907
Mailing Address - Country:US
Mailing Address - Phone:480-292-1110
Mailing Address - Fax:480-634-1200
Practice Address - Street 1:3514 N POWER RD STE 107
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85215-2907
Practice Address - Country:US
Practice Address - Phone:480-292-1110
Practice Address - Fax:480-634-1200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-04
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty