Provider Demographics
NPI:1669205795
Name:SOZO LIFESTYLE MEDICINE PLLC
Entity type:Organization
Organization Name:SOZO LIFESTYLE MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:602-570-9441
Mailing Address - Street 1:10045 E DYNAMITE BLVD STE F130
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85262-3746
Mailing Address - Country:US
Mailing Address - Phone:804-404-4346
Mailing Address - Fax:480-781-0020
Practice Address - Street 1:10045 E DYNAMITE BLVD STE F130
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85262-3746
Practice Address - Country:US
Practice Address - Phone:480-404-4346
Practice Address - Fax:480-781-0020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-23
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty