Healthcare Provider Details

I. General information

NPI: 1922183268
Provider Name (Legal Business Name): ENFIELD AMBULATORY CARE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 PALOMBA DRIVE
ENFIELD CT
06082
US

IV. Provider business mailing address

15 PALOMBA DRIVE
ENFIELD CT
06082
US

V. Phone/Fax

Practice location:
  • Phone: 860-745-1684
  • Fax: 860-741-5228
Mailing address:
  • Phone: 860-745-1684
  • Fax: 860-741-5228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number0039
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number0039
License Number StateCT

VIII. Authorized Official

Name: DR. ALFREDO ARBULU
Title or Position: MEMBER OWNER
Credential:
Phone: 860-745-1684