Organization
SIR ISAAC LLC
Active
Other names
Future health and wellness
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MASSA KIAWOIN LAVANT OWNER (MANAGER)
(763) 639-1269
Entity
Organization
Contact information
Practice address
18275 N 59TH AVE STE 128, GLENDALE, AZ 85308-1252
(763) 639-1269
(602) 938-2283
Mailing address
18275 N 59TH AVE STE 128, GLENDALE, AZ 85308-1252
(763) 639-1269
(602) 938-2283
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
—
—
Other
Enumeration date
06/18/2024
Last updated
06/25/2024
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