Healthcare Provider Details

I. General information

NPI: 1588290944
Provider Name (Legal Business Name): PRESTIGE MEDICAL CARE PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2020
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13000 N 103RD AVE STE 95
SUN CITY AZ
85351-3060
US

IV. Provider business mailing address

3600 N 3RD AVE STE A
PHOENIX AZ
85013-3944
US

V. Phone/Fax

Practice location:
  • Phone: 602-477-9422
  • Fax: 602-675-0924
Mailing address:
  • Phone: 602-477-9422
  • Fax: 602-675-0924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CARLA J ALDAZ
Title or Position: OWNER/PROVIDER
Credential: FNP
Phone: 602-477-8422