MEDICARE: DR. ISMAR CINTORA M.D.

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	174400000X	Specialist	10195	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	42980	OTHER	AZ	UNITED HEALTHCARE
2	1Z2013	OTHER	AZ	HEALTHNET
3	4120200	OTHER	AZ	CIGNA
4	697062	OTHER	AZ	AETNA
5	0002315720	OTHER	AZ	DES
6	AZ0071170	OTHER	AZ	BCBS

General Provider Information

NPI Number	:	1386649796
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ISMAR CINTORA M.D.

Provider Business Mailing Address
First Line	:	2601 N 3RD ST
Second Line	:	STE 203
City	:	PHOENIX
State	:	AZ
Zip	:	85004-1145
Country	:	US
Telephone Number	:	602-279-4442
Fax Number	:	602-279-5333

Provider Business Practice Location Address
First Line	:	2601 N 3RD ST
Second Line	:	STE 203
City	:	PHOENIX
State	:	AZ
Zip	:	85004-1145
Country	:	US
Telephone Number	:	602-279-4442
Fax Number	:	602-279-5333

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2005
Last Update Date	:	07/08/2007

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