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General NPI Number Information
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NPI Number | 1295834604
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Entity Type | Organization
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Legal Business Name | COTTONWOOD INTERNAL MEDICINE PC
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Dates
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Enumeration Date | 09/22/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 450 S WILLARD ST STE 103
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City | COTTONWOOD
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State | AZ
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Zip | 86326
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Country | US
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Telephone | 928-634-4231
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Fax | 928-634-7867
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Provider Business Mailing Address
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Address Line | PO BOX 2019
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City | COTTONWOOD
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State | AZ
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Zip | 86326
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Country | US
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Telephone | 928-634-4231
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Fax | 928-634-7867
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | VALERIE AVIS FALBO
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Credential |
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Telephone | 928-634-2692
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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