# IDENTITY HORMONES LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Identity Hormones LLC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1326642372
- **Authorized official:** AMANDA WILKINSON (BUSINESS OPERATIONS DIRECTOR)
- **Authorized official phone:** (702) 818-0446

## Contact information

- **Practice address:** 100 E CAMELBACK RD STE 108, PHOENIX, AZ 85012-1061
- **Practice address phone:** (901) 757-3643
- **Mailing address:** 100 E CAMELBACK RD STE 108, PHOENIX, AZ 85012-1061

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207QA0505X | Adult Medicine Physician | — | NULL | Yes |
| 207QA0505X | Adult Medicine Physician | — | — | Yes |
| 261QP2300X | Primary Care Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 11/30/2020
- **Last updated:** 11/11/2024