| NPI | 1639650898 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIAM BAUTISTA AMISTAD Provider 480-773-8569 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ AP9557) |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care (Licence: AZ AP9557) |
| Enumeration Date | 2018-08-27 |
| Last Update Date | 2023-09-21 |