| Organization Name: | ANTI-AGING INSTITUTE OF ARIZONA, INC. |
| NPI Number: | 1609185917 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JASON WILLIAMS (MANAGING PARTNER) |
| Mailing Address: | 3514 N Power Rd Ste 107 Mesa |
| State: | AZ US |
| Postal Code: | 852152907 |
| Phone Number: | 4802921110 |
| Fax Number: | 4806341200 |
| NPI Enumeration Date: | 10/04/2010 |
| NPI Last Update Date: | 10/04/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |