Provider Demographics
NPI: | 1851098487 |
---|---|
Name: | BESTLIFE CLINIC, LLC |
Entity Type: | Organization |
Organization Name: | BESTLIFE CLINIC, LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | MEDICAL DIRECTOR |
Authorized Official - Prefix: | |
Authorized Official - First Name: | CYNTHIA |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | GARNER |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DNP |
Authorized Official - Phone: | 602-892-4748 |
Mailing Address - Street 1: | 1430 E MISSOURI AVE STE 165 |
Mailing Address - Street 2: | |
Mailing Address - City: | PHOENIX |
Mailing Address - State: | AZ |
Mailing Address - Zip Code: | 85014-2479 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 602-892-4748 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 1430 E MISSOURI AVE STE 165 |
Practice Address - Street 2: | |
Practice Address - City: | PHOENIX |
Practice Address - State: | AZ |
Practice Address - Zip Code: | 85014-2479 |
Practice Address - Country: | US |
Practice Address - Phone: | 602-892-4748 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2023-02-14 |
Last Update Date: | 2023-02-14 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207PE0005X | Allopathic & Osteopathic Physicians | Emergency Medicine | Undersea and Hyperbaric Medicine | Group - Multi-Specialty |
No | 146L00000X | Emergency Medical Service Providers | Emergency Medical Technician, Paramedic | Group - Multi-Specialty | |
No | 163WW0000X | Nursing Service Providers | Registered Nurse | Wound Care | Group - Multi-Specialty |
No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
No | 207QS0010X | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine | Group - Multi-Specialty |
No | 207RS0010X | Allopathic & Osteopathic Physicians | Internal Medicine | Sports Medicine | Group - Multi-Specialty |
No | 2081P0301X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Brain Injury Medicine | Group - Multi-Specialty |
No | 2081P2900X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Pain Medicine | Group - Multi-Specialty |
No | 2081S0010X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Sports Medicine | Group - Multi-Specialty |
No | 2083P0011X | Allopathic & Osteopathic Physicians | Preventive Medicine | Undersea and Hyperbaric Medicine | Group - Multi-Specialty |
No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Group - Multi-Specialty |