Healthcare Provider Details

I. General information

NPI: 1548734403
Provider Name (Legal Business Name): QC DISTRICT MEDICAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2019
Last Update Date: 05/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21323 S ELLSWORTH LOOP RD STE 101
QUEEN CREEK AZ
85142-9865
US

IV. Provider business mailing address

1450 W GUADALUPE RD STE 120
GILBERT AZ
85233-3056
US

V. Phone/Fax

Practice location:
  • Phone: 480-839-8552
  • Fax: 480-926-2260
Mailing address:
  • Phone: 480-926-7800
  • Fax: 480-926-2260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: MINOO RAHIMI
Title or Position: MANAGER
Credential:
Phone: 480-926-7800