Provider Demographics
NPI:1619732591
Name:IDEAL PERFORMANCE LLC
Entity Type:Organization
Organization Name:IDEAL PERFORMANCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ARMIJO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-489-3962
Mailing Address - Street 1:9299 W OLIVE AVE STE 403
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85345-8383
Mailing Address - Country:US
Mailing Address - Phone:505-489-3962
Mailing Address - Fax:
Practice Address - Street 1:9299 W OLIVE AVE STE 403
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85345-8383
Practice Address - Country:US
Practice Address - Phone:505-489-3962
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-19
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Single Specialty