Healthcare Provider Details

I. General information

NPI: 1972940237
Provider Name (Legal Business Name): ARIZONA CITY HEALTH ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2013
Last Update Date: 05/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13060 SOUTH SUNLAND GIN ROAD
ARIZONA CITY AZ
85123
US

IV. Provider business mailing address

PO BOX 1775
ARIZONA CITY AZ
85123-1290
US

V. Phone/Fax

Practice location:
  • Phone: 520-350-7011
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number005911
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number005911
License Number StateAZ

VIII. Authorized Official

Name: DR. SAMUEL EFRAIN SANCHEZ
Title or Position: CEO
Credential: D.O.
Phone: 562-745-8863