INNOVATIVE PRIMARY CARE OF HAVASU LLC NPI 1619633088

NPI Information

NPI: 1619633088
Provider Name: INNOVATIVE PRIMARY CARE OF HAVASU LLC
Classification: Clinic/Center - 261QP2300X
Entity Type: Organization

Specialization: Primary Care

CLIA Number: 03D2138594

Address:
1945 MESQUITE AVE STE B
LAKE HAVASU CITY, AZ
ZIP 86403
Phone: (928) 733-6287
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INNOVATIVE PRIMARY CARE OF HAVASU LLC is a primary care clinic center in Lake Havasu City, AZ. INNOVATIVE PRIMARY CARE OF HAVASU LLC NPI is 1619633088. The provider is registered as an organization entity type.

The provider's business location address is:

1945 MESQUITE AVE STE B
LAKE HAVASU CITY, AZ
ZIP 86403-889
Phone: (928) 733-6287
Fax: (928) 733-6305

The provider's authorized official is Loida Loyola Arquiza .
The authorized official title is Primary Provider and has the following contact phone number (240) 535-0065.

The CLIA number assigned to this NPI record is 03D2138594 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 11/10/2021 and was last updated on 11/10/2021.

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
1	261QP2300X	Clinic/Center	Primary Care			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	258797	OTHER	ARIZONA	ARIZONA NP LICENSE

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: 11/14/2023

NPI Synchronization or Removal

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