=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508701475
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KERALTY ARIZONA MEDICAL PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/20/2026
-----------------------------------------------------
Last Update Date | 04/20/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3090 N LITCHFIELD RD
-----------------------------------------------------
City | GOODYEAR
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85395-9212
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-529-1016
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8400 NW 33RD ST STE 201
-----------------------------------------------------
City | DORAL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33122-1937
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-529-1016
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | AUTHORIZED OFFICIAL
-----------------------------------------------------
Name | JUAN CARLOS ZARZA MORENO
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 602-529-1016
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------