Organization
EAST VALLEY JOINT CLINIC LLC
Active
Other names
Divine IV and Wellness
Organization subpart
No
Provider details
NPI number
Authorized official
JOOST BERKHOUT (MANAGING MEMBER)
(480) 718-1444
Entity
Organization
Contact information
Practice address
3930 S ALMA SCHOOL RD STE 10, CHANDLER, AZ 85248-4510
(480) 718-1444
(480) 718-7729
Mailing address
3930 S ALMA SCHOOL RD STE 10, CHANDLER, AZ 85248-4510
(480) 718-1444
(480) 718-7729
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
AP5244
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100091
—
AZ
Enumeration date
10/02/2015
Last updated
05/08/2024
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