MEDICARE: PINAL HISPANIC COUNCIL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM1300X	Multi-Specialty Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	BH8501	OTHER	AZ	STATE LICENSE

General Provider Information

NPI Number	:	1063112092
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PINAL HISPANIC COUNCIL

Provider Business Mailing Address
First Line	:	PO BOX 86537
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85754-6537
Country	:	US
Telephone Number	:	520-721-1887
Fax Number	:	520-721-0069

Provider Business Practice Location Address
First Line	:	1667 N TREKELL RD STE 101
Second Line	:
City	:	CASA GRANDE
State	:	AZ
Zip	:	85122-2731
Country	:	US
Telephone Number	:	520-284-5436
Fax Number	:	520-836-5436

Authorized Official
Title or Position	:	PRESIDENT AND CEO
Name	:	ROSE M LOPEZ
Credential	:	MBA
Telephone Number	:	520-721-1887

Provider Enumeration Date	:	03/08/2023
Last Update Date	:	10/27/2025

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Directions to “PINAL HISPANIC COUNCIL ” Practice Location

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