# HAVASU PRIMARY CARE, LTD.

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

## Provider details

- **NPI number:** 1508169616
- **Authorized official:** MANU LONIAL M.D. (PRESIDENT)
- **Authorized official phone:** (928) 453-0777

## Contact information

- **Practice address:** 1830 MESQUITE AVE, SUITE B, LAKE HAVASU CITY, AZ 86403-5885
- **Practice address phone:** (928) 453-0777
- **Practice address fax:** (928) 453-0778
- **Mailing address:** PO BOX 626, LAKE HAVASU CITY, AZ 86405-0626
- **Mailing address phone:** (928) 453-0777
- **Mailing address fax:** (928) 453-0778

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 43225 | AZ | Yes |

## Other

- **Enumeration date:** 12/10/2010
- **Last updated:** 12/10/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 16428743 | CORPORATION REGISTRATION | AZ |