Arizona Essential Holistic Care

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

AP5625 Issued in AZ

Legal business name

ARIZONA ESSENTIAL HOLISTIC CARE

Doing business as

Arizona Essential Holistic Care

Practice address

5700 W Olive Ave Ste 102
Glendale, AZ 85302

Phone

(623) 738-6062

Fax

(602) 354-9462

NPI assigned

May 24, 2018

Last updated

Nov 25, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Alodia Banuelos DomingoNPI 1043635162

Title

Provider/Owner

Phone

(623) 738-6062

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 2

• Arizona Essential Holistic Care Doing business as
• Arizona Essential Holistic Care, LLC Former legal business name

Medicare fee-for-service enrollment

Enrolled in AZ

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 1

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.

• Alodia Banuelos Domingo, NP

  • Family Nurse Practitioner
  • Glendale, AZ
  • NPI 1043635162
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1527120000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1574640000000",
    "number": "1497246482",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5700 W OLIVE AVE STE 102",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853023147",
            "telephone_number": "602-738-6062",
            "fax_number": "602-354-9462"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5700 W OLIVE AVE STE 102",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "85302",
            "telephone_number": "623-738-6062",
            "fax_number": "602-354-9462"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7200 W Bell Rd Bldg B",
            "address_purpose": "LOCATION",
            "city": "Glendale",
            "state": "AZ",
            "postal_code": "853088529",
            "country_code": "US",
            "telephone_number": "602-738-6062",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ARIZONA ESSENTIAL HOLISTIC CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-24",
        "last_updated": "2019-11-25",
        "status": "A",
        "authorized_official_last_name": "DOMINGO",
        "authorized_official_first_name": "ALODIA",
        "authorized_official_middle_name": "BANUELOS",
        "authorized_official_title_or_position": "PROVIDER/OWNER",
        "authorized_official_telephone_number": "623-738-6062"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AZ",
            "license": "AP5625",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTH CARE",
            "identifier": "811065660",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Arizona Essential Holistic Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Arizona Essential Holistic Care, LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Family Medicine Physician in Glendale, AZ
• Providers in Glendale, AZ by specialty
• Family Medicine Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.