Organization
ARIZONA ESSENTIAL HOLISTIC CARE
Active
Other names
Arizona Essential Holistic Care, LLC, Arizona Essential Holistic Care
Organization subpart
No
Provider details
NPI number
Authorized official
ALODIA BANUELOS DOMINGO (PROVIDER/OWNER)
(623) 738-6062
Entity
Organization
Contact information
Practice address
5700 W OLIVE AVE STE 102, GLENDALE, AZ 85302
(623) 738-6062
(602) 354-9462
Mailing address
5700 W OLIVE AVE STE 102, GLENDALE, AZ 85302-3147
(602) 738-6062
(602) 354-9462
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
AP5625
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
811065660
UNITED HEALTH CARE
AZ
Enumeration date
05/24/2018
Last updated
11/25/2019
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