NPIMap

Organization Active NPI

San Luis Walk-in Clinic, Inc.

Doing business as Lake Havasu Pediatric Family Clinic - Mobile Unit

  • Clinic/Center
  • Lake Havasu City, AZ
National Provider Identifier
1770211781
Registry record updated Sep 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
SAN LUIS WALK-IN CLINIC, INC.
Doing business as
Lake Havasu Pediatric Family Clinic - Mobile Unit
Practice address
1940 Mesquite Ave
Lake Havasu City, AZ 86403-6123
Phone
(928) 459-3512
Fax
(928) 459-3514
NPI assigned
Aug 9, 2022
Last updated
Sep 7, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
SAN LUIS WALK-IN CLINIC, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 7, 2023

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

Authorized official

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X NU Primary
Multi-Specialty Clinic/Center 261QM1300X NU

Addresses

Primary practice location

1940 Mesquite Ave
Lake Havasu City, AZ 86403-6123

Mailing address

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

Other names 1

  • Lake Havasu Pediatric Family Clinic - Mobile Unit Doing business as

National Provider Directory

National Provider Directory
Tax ID family
San Luis Walk-in Clinic Inc20 organizations share this tax ID, including this one
Part of
San Luis Walk-in Clinic Inc

Other organizations with this tax ID 19

Organizations that report the same tax identification number in the National Provider Directory.

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1660003200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1694044800000",
    "number": "1770211781",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1940 MESQUITE AVE",
            "city": "LAKE HAVASU CITY",
            "state": "AZ",
            "postal_code": "864036123",
            "telephone_number": "928-459-3512",
            "fax_number": "928-459-3514"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN LUIS WALK-IN CLINIC, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SAN LUIS WALK-IN CLINIC, INC.",
        "enumeration_date": "2022-08-09",
        "last_updated": "2023-09-07",
        "certification_date": "2023-09-07",
        "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": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lake Havasu Pediatric Family Clinic - Mobile Unit",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Lake Havasu Pediatric Family Clinic - Mobile Unit",
            "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 Sep 7, 2023; 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.