Provider Demographics
NPI:1326884800
Name:AZANA THERAPEUTIC RECONDITION INC,
Entity type:Organization
Organization Name:AZANA THERAPEUTIC RECONDITION INC,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:L
Authorized Official - Last Name:GUTIERREZ
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:702-300-6014
Mailing Address - Street 1:8421 GRANITE PEAK CT STE 22
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89145-5430
Mailing Address - Country:US
Mailing Address - Phone:702-300-6014
Mailing Address - Fax:702-906-2361
Practice Address - Street 1:101 S RAINBOW BLVD STE 22101S
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89145-5362
Practice Address - Country:US
Practice Address - Phone:702-300-6014
Practice Address - Fax:702-906-2361
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-03
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
No171400000XOther Service ProvidersHealth & Wellness CoachGroup - Multi-Specialty