Organization
INTEGRATED MEDICAL WELLNESS CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANDRE DREVAL (MANAGING MEMBER)
(602) 400-2800
Entity
Organization
Contact information
Practice address
10184 W HAPPY VALLEY PKWY STE 180, PEORIA, AZ 85383-1254
(480) 289-8464
Mailing address
10184 W HAPPY VALLEY PKWY STE 180, PEORIA, AZ 85383-1254
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
—
—
207RP1001X
Pulmonary Disease Physician
—
—
261Q00000X
Clinic/Center
—
—
261QI0500X
Infusion Therapy Clinic/Center
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Enumeration date
08/06/2020
Last updated
08/23/2020
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