1346086501 NPI number — GATEWAY HEALTH WELLNESS AND AESTHETICS

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346086501 NPI number — GATEWAY HEALTH WELLNESS AND AESTHETICS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GATEWAY HEALTH WELLNESS AND AESTHETICS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1346086501
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/16/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7512 E CLINTON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SCOTTSDALE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85260-6446
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-731-6253
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6000 S MCCLINTOCK DR STE A&B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TEMPE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85283-3266
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-731-6253
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/06/2024

Additional Information

Authorized Official

Authorized Official Last Name:
HARRIS-LANE
Authorized Official First Name:
PANSY
Authorized Official Middle Name:
M
Authorized Official Title or Position:
OWNER/PROVIDER
Authorized Official Telephone Number:
973-731-6253

Provider Taxonomy Codes

  • Taxonomy code: 363LA2100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LF0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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