Healthcare Provider Details

I. General information

NPI: 1396672044
Provider Name (Legal Business Name): PINAL HISPANIC COUNCIL INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10220 N 31ST AVE STE 101
PHOENIX AZ
85051-9562
US

IV. Provider business mailing address

PO BOX 86537
TUCSON AZ
85754-6537
US

V. Phone/Fax

Practice location:
  • Phone: 602-863-1862
  • Fax: 602-234-2639
Mailing address:
  • Phone: 520-721-1887
  • Fax: 520-721-0069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

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