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Organization
SAN JOSE INTEGRATED CLINIC LLC
Active
Organization
SAN JOSE INTEGRATED CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CLARISSE VANESSA NGUEHANANA FNP (CEO)
(928) 722-6098
Entity
Organization
Contact information
Practice address
2000 E JUAN SANCHEZ BLVD, SAN LUIS, AZ 85336-0481
(928) 722-6098
(928) 627-0007
Mailing address
2575 W 24TH ST APT 168, YUMA, AZ 85364-6066
(928) 722-6098
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
—
—
Other
Enumeration date
10/17/2019
Last updated
10/17/2019
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