Provider Demographics
NPI:1922638055
Name:LOTUS HEALTH ARIZONA
Entity Type:Organization
Organization Name:LOTUS HEALTH ARIZONA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CEO
Authorized Official - Prefix:MISS
Authorized Official - First Name:DONISHA
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:PARDUE
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC, PMHNP-BC
Authorized Official - Phone:603-957-0540
Mailing Address - Street 1:3545 W MAUNA LOA LN
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85053-4653
Mailing Address - Country:US
Mailing Address - Phone:603-957-0540
Mailing Address - Fax:
Practice Address - Street 1:2600 E SOUTHERN AVE STE I3
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-7738
Practice Address - Country:US
Practice Address - Phone:603-957-0540
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-16
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health