Healthcare Provider Details

I. General information

NPI: 1235008137
Provider Name (Legal Business Name): HUMBERTO R. INZUNZA PA-C, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2025
Last Update Date: 10/30/2025
Certification Date: 10/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37290 N SCHNEPF RD
SAN TAN VALLEY AZ
85140-9786
US

IV. Provider business mailing address

37290 N SCHNEPF RD
SAN TAN VALLEY AZ
85140-9786
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateNULL

VIII. Authorized Official

Name: HUMBERTO ROBERT INZUNZA
Title or Position: PA-C
Credential: PA-C
Phone: 602-637-2299