Healthcare Provider Details

I. General information

NPI: 1588370134
Provider Name (Legal Business Name): ARIZONA FAMILY CLINICS CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2023
Last Update Date: 01/26/2023
Certification Date: 01/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 N 24TH ST STE 150
PHOENIX AZ
85008-4617
US

IV. Provider business mailing address

1310 N 24TH ST STE 150
PHOENIX AZ
85008-4617
US

V. Phone/Fax

Practice location:
  • Phone: 602-254-0200
  • Fax: 602-254-0237
Mailing address:
  • Phone: 602-254-0200
  • Fax: 602-254-0237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. GUSTAVO DALOTTO
Title or Position: AUTHORIZED OFFICIAL
Credential: PRESIDENT/CEO
Phone: 602-989-5550