Healthcare Provider Details

I. General information

NPI: 1609921378
Provider Name (Legal Business Name): GILA INTERNAL MEDICINE & GERIATRIC P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 08/12/2024
Certification Date: 08/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2727 W BASELINE RD. SUITE 8
TEMPE AZ
85283-1068
US

IV. Provider business mailing address

2727 W. BASELINE RD. SUITE 8
TEMPE AZ
85283-1068
US

V. Phone/Fax

Practice location:
  • Phone: 602-323-0904
  • Fax: 602-243-7616
Mailing address:
  • Phone: 602-323-0904
  • Fax: 602-243-7616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number11483
License Number StateAZ

VIII. Authorized Official

Name: DR. AURELIANO E CIFUENTES
Title or Position: MD/OWNER
Credential: MD
Phone: 602-323-0904