Healthcare Provider Details

I. General information

NPI: 1477908085
Provider Name (Legal Business Name): AMERICAN FAMILY MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2016
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1514 W THOMAS RD
PHOENIX AZ
85015-6101
US

IV. Provider business mailing address

1514 W THOMAS RD
PHOENIX AZ
85015-6101
US

V. Phone/Fax

Practice location:
  • Phone: 602-283-5732
  • Fax: 602-314-4579
Mailing address:
  • Phone: 602-283-5732
  • Fax: 602-314-4579

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: ALEJANDRO E LOPEZ
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 602-283-5732