| NPI | 1245663996 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ADA E CARLOS Accounts Receivable Supervisor 928-329-5447 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: AZ OTC5045) |
| Additional Taxonomies | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2013-08-16 |
| Last Update Date | 2024-06-05 |