SAN JOSE INTEGRATED CLINIC LLC NPI 1386287753

NPI Information

  • NPI: 1386287753
  • Provider Name: SAN JOSE INTEGRATED CLINIC LLC
  • Classification: Nurse Practitioner - 363LF0000X
  • Specialization: Family
  • Entity Type: Organization
  • CLIA Number: 03D1093134
  • Address: 2000 E JUAN SANCHEZ BLVD
    SAN LUIS, AZ
    ZIP 85336
  • Phone: (928) 722-6098

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NPI Details

SAN JOSE INTEGRATED CLINIC LLC is a family nurse practitioner in San Luis, AZ. SAN JOSE INTEGRATED CLINIC LLC NPI is 1386287753. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

2000 E JUAN SANCHEZ BLVD
SAN LUIS, AZ
ZIP 85336-481
Phone: (928) 722-6098
Fax: (928) 627-0007

The provider's authorized official is Clarisse Vanessa Nguehanana .
The authorized official title is Ceo and has the following contact phone number (928) 722-6098.

The CLIA number assigned to this NPI record is 03D1093134 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 10/17/2019 and was last updated on 10/17/2019.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1363LF0000XNurse PractitionerFamilyYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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