| Organization Name: | EAST VALLEY WELLNESS CENTER, LLC |
| NPI Number: | 1023464542 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | GARY A SMITH (OWNER) |
| Mailing Address: | 1301 S Crismon Rd 1669 Mesa |
| State: | AZ US |
| Postal Code: | 852093767 |
| Phone Number: | 4803732399 |
| Fax Number: | 4803732396 |
| NPI Enumeration Date: | 05/13/2016 |
| NPI Last Update Date: | 05/13/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AZ |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |