Organization
INNOVATIVE PRIMARY CARE OF HAVASU LLC
Active
Other names
Innovative Primary Care Clinic of Havasu
Organization subpart
No
Provider details
NPI number
Authorized official
LOIDA LOYOLA ARQUIZA NP (PRIMARY PROVIDER)
(240) 535-0065
Entity
Organization
Contact information
Practice address
1945 MESQUITE AVE STE B, LAKE HAVASU CITY, AZ 86403-5889
(928) 733-6287
(928) 733-6305
Mailing address
1945 MESQUITE AVE STE B, LAKE HAVASU CITY, AZ 86403-5889
(928) 733-6287
(928) 733-6305
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
258797
ARIZONA NP LICENSE
AZ
Enumeration date
11/10/2021
Last updated
11/10/2021
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