Organization
ENLIVEN MBS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VANESSA JANE FONTANILLA RUIZ NMD (NATUROPATHIC MEDICAL DOCTOR)
(347) 470-9766
Entity
Organization
Contact information
Practice address
11000 N SCOTTSDALE RD, STE 230, SCOTTSDALE, AZ 85254-6130
(347) 470-9766
Mailing address
2108 S RURAL RD, #24, TEMPE, AZ 85282-1420
(347) 470-9766
Taxonomy
Speciality
Code
Description
License number
State
175F00000X
Naturopath
Primary
161567
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1194274639
—
AZ
Enumeration date
11/08/2016
Last updated
11/08/2016
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