Healthcare Provider Details

I. General information

NPI: 1245991785
Provider Name (Legal Business Name): MINGUS MOUNTAIN PRIMARY CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2022
Last Update Date: 03/02/2023
Certification Date: 03/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 S WILLARD ST STE 107
COTTONWOOD AZ
86326-6744
US

IV. Provider business mailing address

450 S WILLARD ST STE 107
COTTONWOOD AZ
86326-6744
US

V. Phone/Fax

Practice location:
  • Phone: 928-848-6161
  • Fax:
Mailing address:
  • Phone: 928-649-6080
  • Fax: 928-649-6091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL ARANDA
Title or Position: PROVIDER/OWNER
Credential: DO
Phone: 928-308-3541