Organization
IDENTITY HORMONES LLC
Active
Other names
Identity Hormones LLC
Organization subpart
No
Provider details
NPI number
Authorized official
AMANDA WILKINSON (BUSINESS OPERATIONS DIRECTOR)
(702) 818-0446
Entity
Organization
Contact information
Practice address
100 E CAMELBACK RD STE 108, PHOENIX, AZ 85012-1061
(901) 757-3643
Mailing address
100 E CAMELBACK RD STE 108, PHOENIX, AZ 85012-1061
Taxonomy
Speciality
Code
Description
License number
State
207QA0505X
Adult Medicine Physician
Primary
—
—
261QP2300X
Primary Care Clinic/Center
—
—
Other
Enumeration date
11/30/2020
Last updated
11/11/2024
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