Healthcare Provider Details

I. General information

NPI: 1235003112
Provider Name (Legal Business Name): ARIZONA FAMILY HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2025
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13945 W GRAND AVE # A101
SURPRISE AZ
85374-2437
US

IV. Provider business mailing address

13945 W GRAND AVE STE 101
SURPRISE AZ
85374-2437
US

V. Phone/Fax

Practice location:
  • Phone: 623-263-2986
  • Fax: 623-278-8636
Mailing address:
  • Phone: 480-944-4298
  • Fax: 866-538-7155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2081H0002X
TaxonomyHospice and Palliative Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: ZAK CORONADO
Title or Position: ADMINISTRATOR
Credential:
Phone: 623-521-9113