Provider Demographics
NPI:1639885031
Name:BESO WELLNESS AND LONGEVITY CENTER, PLLC
Entity Type:Organization
Organization Name:BESO WELLNESS AND LONGEVITY CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:NAOMI
Authorized Official - Middle Name:
Authorized Official - Last Name:FAYZULAYEV
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC
Authorized Official - Phone:480-447-8166
Mailing Address - Street 1:4731 E UNION HILLS DR STE 114
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85050-3319
Mailing Address - Country:US
Mailing Address - Phone:480-447-8166
Mailing Address - Fax:480-562-5913
Practice Address - Street 1:4731 E UNION HILLS DR STE 114
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85050-3319
Practice Address - Country:US
Practice Address - Phone:480-447-8166
Practice Address - Fax:480-562-5913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-30
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty