Provider Demographics
NPI:1982372488
Name:SPECTRUM OF VIBES, LLC
Entity Type:Organization
Organization Name:SPECTRUM OF VIBES, LLC
Other - Org Name:SPECTRUM PSYCHIATRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:MS
Authorized Official - First Name:MEAZA
Authorized Official - Middle Name:G
Authorized Official - Last Name:EJIGU
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:623-680-5243
Mailing Address - Street 1:PO BOX 11433
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85248-0008
Mailing Address - Country:US
Mailing Address - Phone:480-372-4135
Mailing Address - Fax:602-671-6997
Practice Address - Street 1:64 E BROADWAY RD STE 200
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-1377
Practice Address - Country:US
Practice Address - Phone:480-372-4135
Practice Address - Fax:602-671-6997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-31
Last Update Date:2024-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty