Az Wellness Clinic LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

AZ WELLNESS CLINIC LLC

Practice address

6114 N 59TH Ave Ste 4
Glendale, AZ 85301-7769

Phone

(623) 937-8643

NPI assigned

Mar 13, 2019

Last updated

Mar 13, 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

Liban Almaguer

Title

Owner

Phone

(623) 937-8643

Specialties & licenses 2

Addresses

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.

• Ahecio Alexander Labrada Izquierdo, APRN

  • Family Nurse Practitioner
  • Phoenix, AZ
  • NPI 1083215735
  NPD

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

{
    "created_epoch": "1552435200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1552435200000",
    "number": "1619436292",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6114 N 59TH AVE STE 4",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853017769"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6114 N 59TH AVE STE 4",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853017769",
            "telephone_number": "623-937-8643"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AZ WELLNESS CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-03-13",
        "last_updated": "2019-03-13",
        "status": "A",
        "authorized_official_last_name": "ALMAGUER",
        "authorized_official_first_name": "LIBAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "623-937-8643"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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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 Mar 13, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.