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General NPI Number Information
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NPI Number | 1356410146
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Entity Type | Organization
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Legal Business Name | MAIN STREET FAMILY PRACTICE, P.C.
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Dates
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Enumeration Date | 11/07/2006
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Last Update Date | 05/21/2015
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Provider Practice Location Address
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Address Line | 660 SOUTH MAIN STREET
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City | FLORENCE
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State | AZ
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Zip | 85232
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Country | US
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Telephone | 949-713-3998
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2818
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City | FLORENCE
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State | AZ
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Zip | 85132-3052
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Country | US
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Telephone | 520-868-1400
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Fax | 520-868-1500
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Authorized Official
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Title or Position | OWNER
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Name | BETH M LIZARRAGA
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Credential |
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Telephone | 520-868-1400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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