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201 W Guadalupe Rd Ste 310 Gilbert AZ 85233-3319 | |
| (480) 619-2868 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 201 W Guadalupe Rd Ste 310, Gilbert, Arizona |
| Authorized Official Name and Position | Mason Lundell (MANAGER) |
| Authorized Official Contact | 4806192868 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
2312 E Orleans Dr Gilbert AZ 85298-0323 Ph: (480) 619-2868 | 201 W Guadalupe Rd Ste 310 Gilbert AZ 85233-3319 Ph: (480) 619-2868 |
| NPI Number | 1578274346 |
|---|---|
| Provider Enumeration Date | 12/12/2022 |
| Last Update Date | 09/27/2024 |
| Certification Date | 09/27/2024 |
| Medicare PECOS PAC ID | 8527424100 |
|---|---|
| Medicare Enrollment ID | O20230524002283 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578274346 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | John J Lee |
|---|---|
| Provider Type | Practitioner - Osteopathic Manipulative Medicine |
| Provider Identifiers | NPI Number: 1568534741 PECOS PAC ID: 9335153881 Enrollment ID: I20060203000413 |
| Provider Name | Jerica Elaine M Lim |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043884026 PECOS PAC ID: 7618379447 Enrollment ID: I20210715001933 |
| Provider Name | Hyrum Marriott Candland |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821853102 PECOS PAC ID: 4183155872 Enrollment ID: I20241004003228 |
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