Provider Demographics
NPI:1528786324
Name:RISING PHOENIX NATURAL HEALTH, PLLC
Entity type:Organization
Organization Name:RISING PHOENIX NATURAL HEALTH, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRACTITIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:DI DIEGO
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:507-412-1219
Mailing Address - Street 1:47544 105TH ST
Mailing Address - Street 2:
Mailing Address - City:TRUMAN
Mailing Address - State:MN
Mailing Address - Zip Code:56088-2172
Mailing Address - Country:US
Mailing Address - Phone:520-227-1505
Mailing Address - Fax:
Practice Address - Street 1:105 CENTER AVE N
Practice Address - Street 2:
Practice Address - City:MADELIA
Practice Address - State:MN
Practice Address - Zip Code:56062-1429
Practice Address - Country:US
Practice Address - Phone:507-412-1219
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-17
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care