# INNOVATIVE DIABETIC CENTER, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1235997602
- **Authorized official:** AMY LORRAINE HUNN (PRESIDENT)
- **Authorized official phone:** (480) 493-0900

## Contact information

- **Practice address:** 10210 N 92ND ST STE 104, SCOTTSDALE, AZ 85258-4531
- **Practice address phone:** (480) 493-0900
- **Practice address fax:** (833) 228-0846
- **Mailing address:** 10210 N 92ND ST STE 104, SCOTTSDALE, AZ 85258-4531
- **Mailing address phone:** (480) 493-0900
- **Mailing address fax:** (833) 228-0846

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 133N00000X | Nutritionist | — | NULL | — |
| 133N00000X | Nutritionist | — | — | — |
| 133VN1006X | Metabolic Nutrition Registered Dietitian | — | NULL | — |
| 133VN1006X | Metabolic Nutrition Registered Dietitian | — | — | — |
| 163WD0400X | Diabetes Educator Registered Nurse | — | NULL | — |
| 163WD0400X | Diabetes Educator Registered Nurse | — | — | — |
| 163WI0500X | Infusion Therapy Registered Nurse | — | NULL | — |
| 163WI0500X | Infusion Therapy Registered Nurse | — | — | — |
| 164W00000X | Licensed Practical Nurse | — | NULL | — |
| 164W00000X | Licensed Practical Nurse | — | — | — |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 207RE0101X | Endocrinology, Diabetes & Metabolism Physician | — | NULL | — |
| 207RE0101X | Endocrinology, Diabetes & Metabolism Physician | — | — | — |
| 2081P2900X | Pain Medicine (Physical Medicine & Rehabilitation) Physician | — | NULL | — |
| 2081P2900X | Pain Medicine (Physical Medicine & Rehabilitation) Physician | — | — | — |
| 208VP0000X | Pain Medicine Physician | — | NULL | — |
| 208VP0000X | Pain Medicine Physician | — | — | — |
| 261QI0500X | Infusion Therapy Clinic/Center | — | NULL | — |
| 261QM1300X | Multi-Specialty Clinic/Center | — | NULL | — |
| 363L00000X | Nurse Practitioner | — | NULL | — |
| 363L00000X | Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 03/11/2024
- **Last updated:** 12/31/2025