Organization
DESERT LIFE PRIMARY CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN WOODHAM (OWNER)
(760) 464-4944
Entity
Organization
Contact information
Practice address
3035 S ELLSWORTH RD STE 121, MESA, AZ 85212-2137
(480) 280-7229
Mailing address
3035 S ELLSWORTH RD STE 121, MESA, AZ 85212-2137
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
—
363L00000X
Nurse Practitioner
Primary
—
—
Other
Enumeration date
07/26/2021
Last updated
11/17/2021
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