| NPI | 1407929920 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ISMAEL INCLAN GUERRERO Owner 928-344-5951 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 21545) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AZ 2891) |
| 363A00000X Physician Assistant (Licence: AZ 1458) | |
| 363A00000X Physician Assistant (Licence: AZ 2125) | |
| Enumeration Date | 2006-11-15 |
| Last Update Date | 2013-03-06 |