Healthcare Provider Details

I. General information

NPI: 1003444175
Provider Name (Legal Business Name): AZ CARE HEALTH PLAN, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2020
Last Update Date: 04/01/2020
Certification Date: 04/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20565 N 19TH AVE
PHOENIX AZ
85027-3563
US

IV. Provider business mailing address

4611 WINTHROP DR
HUNTINGTON BEACH CA
92649-6417
US

V. Phone/Fax

Practice location:
  • Phone: 818-399-8996
  • Fax: 855-959-2273
Mailing address:
  • Phone: 818-399-8996
  • Fax: 866-627-3093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State

VIII. Authorized Official

Name: MS. LAN NHU BICH PHAN
Title or Position: CHIEF OPERATING OFFICER
Credential: MPH
Phone: 818-399-8996