Provider Demographics
NPI:1841699030
Name:ARIZONA MEDICAL WELLNESS CENTER, LLC
Entity type:Organization
Organization Name:ARIZONA MEDICAL WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:A
Authorized Official - Last Name:AWAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-782-1061
Mailing Address - Street 1:201 W GUADALUPE RD
Mailing Address - Street 2:#200
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85233-3332
Mailing Address - Country:US
Mailing Address - Phone:480-782-1061
Mailing Address - Fax:480-813-4728
Practice Address - Street 1:201 W GUADALUPE RD
Practice Address - Street 2:#200
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85233-3332
Practice Address - Country:US
Practice Address - Phone:480-782-1061
Practice Address - Fax:480-813-4728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-14
Last Update Date:2014-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ36884207R00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty