Healthcare Provider Details

I. General information

NPI: 1114274446
Provider Name (Legal Business Name): YUMA COMMUNITY PHYSICIANS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2012
Last Update Date: 08/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2435 S AVENUE A STE A
YUMA AZ
85364-7176
US

IV. Provider business mailing address

PO BOX 5609
YUMA AZ
85366-5609
US

V. Phone/Fax

Practice location:
  • Phone: 928-782-4791
  • Fax: 928-782-6269
Mailing address:
  • Phone: 928-782-4791
  • Fax: 928-782-6269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBERTO PEREZ GARCIA
Title or Position: AUTHORIZED MEMBER
Credential:
Phone: 928-782-4791