| Well Life Llc | |
|
1700 W Whitton Ave Phoenix AZ 85015-5533 | |
| (602) 318-4383 | |
| Not Available |
| Full Name | Well Life Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1700 W Whitton Ave, Phoenix, Arizona |
| Authorized Official Name and Position | Anthony Populo (FOUNDER) |
| Authorized Official Contact | 6023184383 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Well Life Llc 1700 W Whitton Ave Phoenix AZ 85015-5533 Ph: (602) 318-4383 | Well Life Llc 1700 W Whitton Ave Phoenix AZ 85015-5533 Ph: (602) 318-4383 |
| NPI Number | 1356054860 |
|---|---|
| Provider Enumeration Date | 12/29/2022 |
| Last Update Date | 05/01/2023 |
| Medicare PECOS PAC ID | 0345606349 |
|---|---|
| Medicare Enrollment ID | O20230517002316 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356054860 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Anthony Populo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033739081 PECOS PAC ID: 3870994452 Enrollment ID: I20210702001849 |
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