Provider Demographics
NPI:1679326623
Name:NEW WAVE MEDICAL AZ
Entity Type:Organization
Organization Name:NEW WAVE MEDICAL AZ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CUSTOMER SUCCESS TEAM
Authorized Official - Prefix:
Authorized Official - First Name:DALIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ELIZALDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:844-327-2199
Mailing Address - Street 1:711 VALARIE ST
Mailing Address - Street 2:
Mailing Address - City:RIDGECREST
Mailing Address - State:CA
Mailing Address - Zip Code:93555-5940
Mailing Address - Country:US
Mailing Address - Phone:844-327-2199
Mailing Address - Fax:844-337-7304
Practice Address - Street 1:2828 N CENTRAL AVE FL 10
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-1236
Practice Address - Country:US
Practice Address - Phone:844-327-2199
Practice Address - Fax:844-337-7304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-09
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty