Healthcare Provider Details

I. General information

NPI: 1376650770
Provider Name (Legal Business Name): EDUARDO S ALCANTAR MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2078 E SOUTHERN AVE STE D101
TEMPE AZ
85282-7545
US

IV. Provider business mailing address

8732 E CLARENDON AVE
SCOTTSDALE AZ
85251-5050
US

V. Phone/Fax

Practice location:
  • Phone: 480-968-9890
  • Fax: 480-968-9895
Mailing address:
  • Phone: 480-947-9749
  • Fax: 480-968-9895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3275
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN106409
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number17509
License Number StateAZ

VIII. Authorized Official

Name: DR. EDUARDO SALCIDO ALCANTAR
Title or Position: OWNER
Credential: MD PC
Phone: 480-968-9890