Healthcare Provider Details

I. General information

NPI: 1417543117
Provider Name (Legal Business Name): CARLOS ALBERTO CHING FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: CARLOS ALBERTO CHING CARLOS A. CHING, FNP

II. Dates (important events)

Enumeration Date: 12/16/2020
Last Update Date: 06/08/2023
Certification Date: 06/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 W SUNRISE DR
PHOENIX AZ
85041-9137
US

IV. Provider business mailing address

1520 W SUNRISE DR
PHOENIX AZ
85041-9137
US

V. Phone/Fax

Practice location:
  • Phone: 602-578-0627
  • Fax:
Mailing address:
  • Phone: 602-578-0627
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number250847
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: