Healthcare Provider Details

I. General information

NPI: 1285305417
Provider Name (Legal Business Name): CITIZENS INTEGRATED FAMILY PRACTICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2021
Last Update Date: 10/12/2022
Certification Date: 10/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

288 N IRONWOOD DR STE 112
APACHE JUNCTION AZ
85120-3830
US

IV. Provider business mailing address

1530 E WILLIAMS FIELD RD STE 201
GILBERT AZ
85295-1825
US

V. Phone/Fax

Practice location:
  • Phone: 515-867-1918
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NOAH KIPKORIR SANG
Title or Position: ADMINISTRATOR
Credential: AGACNP, FNP
Phone: 480-406-1132