Healthcare Provider Details

I. General information

NPI: 1194277426
Provider Name (Legal Business Name): WOMEN'S MEDICAL & GYN CENTRE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2016
Last Update Date: 12/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2055 HIGHWAY 95
BULLHEAD CITY AZ
86442-6004
US

IV. Provider business mailing address

2055 HIGHWAY 95
BULLHEAD CITY AZ
86442-6004
US

V. Phone/Fax

Practice location:
  • Phone: 928-758-1010
  • Fax: 928-758-1428
Mailing address:
  • Phone: 928-758-1010
  • Fax: 928-758-1428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number21702
License Number StateAZ

VIII. Authorized Official

Name: DR. JOSE HIRAM ALVAREZ
Title or Position: OWNER/PROVIDER
Credential: M.D.
Phone: 928-758-1010