Healthcare Provider Details

I. General information

NPI: 1639360118
Provider Name (Legal Business Name): NESTOR N. NAZARENO MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2007
Last Update Date: 09/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14420 W MEEKER BLVD STE 109
SUN CITY WEST AZ
85375-5287
US

IV. Provider business mailing address

14420 W MEEKER BLVD STE 109
SUN CITY WEST AZ
85375-5287
US

V. Phone/Fax

Practice location:
  • Phone: 623-544-3522
  • Fax: 623-544-3520
Mailing address:
  • Phone: 623-544-3522
  • Fax: 623-544-3520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number23491
License Number StateAZ

VIII. Authorized Official

Name: MRS. CATHERINE MARIE AGREDASALAS
Title or Position: PRACTICE MANAGER
Credential: M.A.
Phone: 623-544-3522