NPIMap

Organization Active NPI

San Luis Walk-in Clinic, Inc.

Doing business as Lake Havasu Pediatric Family Clinic

  • Rural Health Clinic/Center
  • Lake Havasu City, AZ
National Provider Identifier
1154051753
Registry record updated Oct 20, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
SAN LUIS WALK-IN CLINIC, INC.
Doing business as
Lake Havasu Pediatric Family Clinic
Practice address
1980 Mesquite Ave Ste 103
Lake Havasu City, AZ 86403-7713
Phone
(928) 392-3691
Fax
(928) 392-3693
NPI assigned
Jun 15, 2022
Last updated
Oct 20, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 20, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Amanda AguirreNPI 1942615760
Title
President & Ceo
Phone
(928) 315-7910

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

1980 Mesquite Ave Ste 103
Lake Havasu City, AZ 86403-7713

Mailing address

PO Box 617
Somerton, AZ 85350-0617
Phone (928) 315-7910

Other names 1

  • LAKE HAVASU PEDIATRIC FAMILY CLINIC Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040514000795 AZ Part B Supplier - Clinic/Group Practice 2668361841 Receives reassigned benefits from 88 practitioners
18 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Somerton, AZ; Yuma, AZ; San Luis, AZ; Kingman, AZ; Parker, AZ; Lake Havasu City, AZ

Other NPIs on the same Medicare enrollment 18

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 18

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 26

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 26

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1655251200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1792454400000",
    "number": "1154051753",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 617",
            "city": "SOMERTON",
            "state": "AZ",
            "postal_code": "853500617",
            "telephone_number": "928-315-7910",
            "fax_number": "928-722-6113"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1980 MESQUITE AVE STE 103",
            "city": "LAKE HAVASU CITY",
            "state": "AZ",
            "postal_code": "864037713",
            "telephone_number": "928-392-3691",
            "fax_number": "928-392-3693"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN LUIS WALK-IN CLINIC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-06-15",
        "last_updated": "2026-10-20",
        "certification_date": "2026-10-20",
        "status": "A",
        "authorized_official_last_name": "AGUIRRE",
        "authorized_official_first_name": "AMANDA",
        "authorized_official_title_or_position": "PRESIDENT & CEO",
        "authorized_official_telephone_number": "928-315-7910"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LAKE HAVASU PEDIATRIC FAMILY CLINIC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "LAKE HAVASU PEDIATRIC FAMILY CLINIC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lake Havasu City, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.