Healthcare Provider Details

I. General information

NPI: 1235271404
Provider Name (Legal Business Name): PINAL HISPANIC COUNCIL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 10/27/2025
Certification Date: 10/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 EAST 4TH STREET
ELOY AZ
85131-2500
US

IV. Provider business mailing address

PO BOX 86537
TUCSON AZ
85754-6537
US

V. Phone/Fax

Practice location:
  • Phone: 520-466-7765
  • Fax: 520-466-4475
Mailing address:
  • Phone: 520-721-1887
  • Fax: 520-721-0069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberBH-3952
License Number StateAZ

VIII. Authorized Official

Name: ROSE M LOPEZ
Title or Position: PRESIDENT AND CEO
Credential: MBA
Phone: 520-721-1887