Healthcare Provider Details

I. General information

NPI: 1780668921
Provider Name (Legal Business Name): CLINICA LA FAMILIA, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2005
Last Update Date: 11/25/2024
Certification Date: 11/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13402 N 32ND ST
PHOENIX AZ
85032-6047
US

IV. Provider business mailing address

1533 E WILLETTA ST
PHOENIX AZ
85006-2935
US

V. Phone/Fax

Practice location:
  • Phone: 602-569-3999
  • Fax: 602-569-3887
Mailing address:
  • Phone: 602-569-3999
  • Fax: 602-569-3887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number32998
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number29615
License Number StateAZ

VIII. Authorized Official

Name: DR. RICARDO G. CELAYA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 602-569-3999