Healthcare Provider Details

I. General information

NPI: 1184973018
Provider Name (Legal Business Name): NCA HOLDINGS OF ARIZONA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2012
Last Update Date: 12/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13090 N 94TH DR SUITE 101
PEORIA AZ
85381-4256
US

IV. Provider business mailing address

7558 W THUNDERBIRD RD SUITE 1-496
PEORIA AZ
85381-6080
US

V. Phone/Fax

Practice location:
  • Phone: 623-977-2707
  • Fax: 623-977-2331
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateAZ

VIII. Authorized Official

Name: DR. ALI H ALAVI
Title or Position: OWNER
Credential: DO
Phone: 817-602-2626