Provider Demographics
NPI:1891450474
Name:SANANDO INTEGRATIVE MED CLINIC, PLLC
Entity type:Organization
Organization Name:SANANDO INTEGRATIVE MED CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CECILIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ RUIZ
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:928-388-5473
Mailing Address - Street 1:PO BOX 430
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS
Mailing Address - State:AZ
Mailing Address - Zip Code:85349-0430
Mailing Address - Country:US
Mailing Address - Phone:928-388-5473
Mailing Address - Fax:
Practice Address - Street 1:2000 E. CESAR CHAVEZ BLVD
Practice Address - Street 2:
Practice Address - City:SAN LUIS
Practice Address - State:AZ
Practice Address - Zip Code:85336
Practice Address - Country:US
Practice Address - Phone:928-388-5473
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-08
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty