Provider Demographics
NPI:1053584516
Name:ARIZONA MEDICAL AND NATURAL HEALTH CLINIC
Entity type:Organization
Organization Name:ARIZONA MEDICAL AND NATURAL HEALTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NATUROPATHIC MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIKA
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:MCKEEN
Authorized Official - Suffix:
Authorized Official - Credentials:NMD
Authorized Official - Phone:623-266-1700
Mailing Address - Street 1:34406 N 27TH DR BLDG 2
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85085-6082
Mailing Address - Country:US
Mailing Address - Phone:623-266-1700
Mailing Address - Fax:623-322-0973
Practice Address - Street 1:34406 N 27TH DR BLDG 2
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85085-6082
Practice Address - Country:US
Practice Address - Phone:623-266-1700
Practice Address - Fax:623-322-0973
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-04
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ07-1035175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ07-1035OtherAZ LICENSE