| Wellness Integrative, Plc | |
|
1207 W 16th St Ste B Yuma AZ 85364-4597 | |
| (928) 318-6310 | |
| (928) 328-1056 |
| Full Name | Wellness Integrative, Plc |
|---|---|
| Speciality | Family Medicine |
| Location | 1207 W 16th St Ste B, Yuma, Arizona |
| Authorized Official Name and Position | Jennivyr Derakhshan (OWNER) |
| Authorized Official Contact | 9283186910 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wellness Integrative, Plc 1207 W 16th St Ste B Yuma AZ 85364-4597 Ph: (928) 318-6310 | Wellness Integrative, Plc 1207 W 16th St Ste B Yuma AZ 85364-4597 Ph: (928) 318-6310 |
| NPI Number | 1619330388 |
|---|---|
| Provider Enumeration Date | 03/31/2016 |
| Last Update Date | 04/15/2020 |
| Medicare PECOS PAC ID | 7315246758 |
|---|---|
| Medicare Enrollment ID | O20160505002180 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619330388 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Tammy L Slade Florez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174628283 PECOS PAC ID: 8426057167 Enrollment ID: I20061207000197 |
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