Provider Demographics
NPI:1265600027
Name:ALLERGY AND ENVIRONMENTAL TREATMENT CENTER, LLC
Entity type:Organization
Organization Name:ALLERGY AND ENVIRONMENTAL TREATMENT CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:GWOZDEK
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:480-634-2985
Mailing Address - Street 1:8776 E SHEA BLVD
Mailing Address - Street 2:SUITE B3A-304
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-6629
Mailing Address - Country:US
Mailing Address - Phone:480-634-2985
Mailing Address - Fax:480-634-2987
Practice Address - Street 1:8952 E DESERT COVE AVE STE 114
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-6776
Practice Address - Country:US
Practice Address - Phone:480-634-2985
Practice Address - Fax:480-634-2987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-14
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X, 207R00000X, 261Q00000X, 261QM1300X
AZRN139630261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty