Healthcare Provider Details

I. General information

NPI: 1548830789
Provider Name (Legal Business Name): CHRISTIAN CARE MEDICAL FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2021
Last Update Date: 01/11/2023
Certification Date: 01/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5418 E SKYLINE DR
SAN TAN VALLEY AZ
85140-9000
US

IV. Provider business mailing address

5330 E SKYLINE DR
SAN TAN VALLEY AZ
85140-9023
US

V. Phone/Fax

Practice location:
  • Phone: 480-776-9417
  • Fax: 480-907-2110
Mailing address:
  • Phone: 480-776-9417
  • Fax: 323-313-0317

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateNULL
# 6
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number StateNULL

VIII. Authorized Official

Name: HUMBERTO ROBERT INZUNZA
Title or Position: CEO
Credential: PHYSICIAN ASSISTANT
Phone: 480-776-9417