Basic Information
| Provider Information | |||||||||
| NPI: | 1154645273 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | 5 MINUTE WALK-IN CLINIC LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1962 E. JUAN SANCHEZ BLVD | ||||||||
| Address2: | STE C-2 | ||||||||
| City: | SAN LUIS | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85349 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9286274963 | ||||||||
| FaxNumber: | 9286279105 | ||||||||
| Practice Location | |||||||||
| Address1: | 1962 E. JUAN SANCHEZ BLVD | ||||||||
| Address2: | STE C-2 | ||||||||
| City: | SAN LUIS | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85349 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9286274963 | ||||||||
| FaxNumber: | 9286279105 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/18/2010 | ||||||||
| LastUpdateDate: | 02/27/2020 | ||||||||
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| AuthorizedOfficialLastName: | VEGA | ||||||||
| AuthorizedOfficialFirstName: | GILBERT | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9285034261 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PA-C | ||||||||
| NPICertificationDate: | 02/27/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 3434 | AZ | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.