Provider Demographics
NPI:1780881375
Name:ARROWHEAD MEDICAL AND AESTHETIC CENTER LLC
Entity type:Organization
Organization Name:ARROWHEAD MEDICAL AND AESTHETIC CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:ESPIRITU
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:623-434-0336
Mailing Address - Street 1:20325 N 51ST AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-5674
Mailing Address - Country:US
Mailing Address - Phone:623-434-0336
Mailing Address - Fax:623-825-2545
Practice Address - Street 1:20325 N 51ST AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-5674
Practice Address - Country:US
Practice Address - Phone:623-434-0336
Practice Address - Fax:623-825-2545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-28
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ31859AZ261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ823030Medicaid
AZZ124160OtherPTAN
AZH98856Medicare UPIN
AZ103485Medicare ID - Type Unspecified
AZZ124160OtherPTAN