Innovative Primary Care of Havasu LLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

INNOVATIVE PRIMARY CARE OF HAVASU LLC

Practice address

1945 Mesquite Ave Ste B
Lake Havasu City, AZ 86403-5889

Phone

(928) 733-6287

Fax

(928) 733-6305

NPI assigned

Nov 10, 2021

Organization subpart

No

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

Authorized official

Name

Loida Loyola Arquiza, NP

Title

Primary Provider

Phone

(240) 535-0065

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Innovative Primary Care Clinic of Havasu Doing business as

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

{
    "created_epoch": "1636502400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1636502400000",
    "number": "1619633088",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1945 MESQUITE AVE STE B",
            "city": "LAKE HAVASU CITY",
            "state": "AZ",
            "postal_code": "864035889",
            "telephone_number": "928-733-6287",
            "fax_number": "928-733-6305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1945 MESQUITE AVE STE B",
            "city": "LAKE HAVASU CITY",
            "state": "AZ",
            "postal_code": "864035889",
            "telephone_number": "928-733-6287",
            "fax_number": "928-733-6305"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNOVATIVE PRIMARY CARE OF HAVASU LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-11-10",
        "last_updated": "2021-11-10",
        "certification_date": "2021-11-10",
        "status": "A",
        "authorized_official_last_name": "ARQUIZA",
        "authorized_official_first_name": "LOIDA",
        "authorized_official_middle_name": "LOYOLA",
        "authorized_official_title_or_position": "PRIMARY PROVIDER",
        "authorized_official_telephone_number": "240-535-0065",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ARIZONA NP LICENSE",
            "identifier": "258797",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Innovative Primary Care Clinic of Havasu",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Florentyna Nnenne Igboanugo, PHARMD
• Roxana Imanian, DMD
• Innovative Health and Wellness Center
• Innovative Health Care of Havasu LLC
• Innovative Primary Care Clinic of Havasu PLLC
• Innovative Primary Care of Lake Havasu LLC
• Innovative Womens Health Care of Havasu PLLC
• Institute for Male Health&Performance LLC
• Integrated Wellness Club
• Integrative Oncology Strategies,LLC

• All providers in Lake Havasu City, AZ
• Primary Care Clinic/Center in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2021; 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.