Provider Demographics
NPI:1750957270
Name:AZ INTEGRATED MEDICINE
Entity type:Organization
Organization Name:AZ INTEGRATED MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:L
Authorized Official - Last Name:WOJSLAW
Authorized Official - Suffix:
Authorized Official - Credentials:NMD
Authorized Official - Phone:480-502-9487
Mailing Address - Street 1:7558 W THUNDERBIRD RD STE 1-460
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-6080
Mailing Address - Country:US
Mailing Address - Phone:480-502-9487
Mailing Address - Fax:855-313-5053
Practice Address - Street 1:17431 N 71ST DR STE 102
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-8598
Practice Address - Country:US
Practice Address - Phone:480-502-9487
Practice Address - Fax:855-313-5053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-03
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center