MEDICARE: KERALTY ARIZONA MEDICAL PC

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	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1356286256
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KERALTY ARIZONA MEDICAL PC

Provider Business Mailing Address
First Line	:	8400 NW 33RD ST STE 201
Second Line	:
City	:	DORAL
State	:	FL
Zip	:	33122-1937
Country	:	US
Telephone Number	:	602-529-1016
Fax Number	:

Provider Business Practice Location Address
First Line	:	20414 N 27TH AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85027-3250
Country	:	US
Telephone Number	:	602-529-1016
Fax Number	:

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	JUAN CARLOS ZARZA MORENO
Credential	:	MD
Telephone Number	:	602-529-1016

Provider Enumeration Date	:	04/20/2026
Last Update Date	:	06/02/2026

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