# SANANDO INTEGRATIVE MED CLINIC, PLLC

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

## Provider details

- **NPI number:** 1891450474
- **Authorized official:** CECILIA GONZALEZ RUIZ PA (CEO)
- **Authorized official phone:** (928) 388-5473

## Contact information

- **Practice address:** 2000 E. CESAR CHAVEZ BLVD, SAN LUIS, AZ 85336
- **Practice address phone:** (928) 388-5473
- **Mailing address:** PO BOX 430, SAN LUIS, AZ 85349-0430
- **Mailing address phone:** (928) 388-5473

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 11/08/2021
- **Last updated:** 03/08/2022