MEDICARE: NEW HORIZON MEDICAL CENTER, LLC

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	207N00000X	Dermatology Physician
2	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1962147694
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW HORIZON MEDICAL CENTER, LLC

Provider Business Mailing Address
First Line	:	3201 W PEORIA AVE STE D805
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85029-4600
Country	:	US
Telephone Number	:	602-569-5437
Fax Number	:	855-583-3686

Provider Business Practice Location Address
First Line	:	3201 W PEORIA AVE STE D805
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85029-4600
Country	:	US
Telephone Number	:	602-569-5437
Fax Number	:	855-583-3686

Authorized Official
Title or Position	:	CEO
Name	:	MIRTA DALOTTO
Credential	:
Telephone Number	:	602-569-5437

Provider Enumeration Date	:	04/27/2022
Last Update Date	:	02/21/2025

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