Provider Demographics
NPI:1750604989
Name:SUNRIDGE MEDICAL WELLNES CENTER
Entity type:Organization
Organization Name:SUNRIDGE MEDICAL WELLNES CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GIOACCHINO
Authorized Official - Middle Name:VINCENZO
Authorized Official - Last Name:FRANCO
Authorized Official - Suffix:
Authorized Official - Credentials:NMD
Authorized Official - Phone:480-659-9155
Mailing Address - Street 1:14200 N NORTHSIGHT BLVD
Mailing Address - Street 2:SUITE 160
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-3947
Mailing Address - Country:US
Mailing Address - Phone:480-659-9135
Mailing Address - Fax:800-659-9035
Practice Address - Street 1:14200 N NORTHSIGHT BLVD
Practice Address - Street 2:SUITE 160
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-3947
Practice Address - Country:US
Practice Address - Phone:480-659-9135
Practice Address - Fax:800-659-9035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-02
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ04-839261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ04839OtherSTATE LICENSURE