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General NPI Number Information
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NPI Number | 1548830789
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Entity Type | Organization
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Legal Business Name | CHRISTIAN CARE MEDICAL FOUNDATION
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Dates
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Enumeration Date | 06/29/2021
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Last Update Date | 01/11/2023
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Provider Practice Location Address
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Address Line | 5418 E SKYLINE DR
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City | SAN TAN VALLEY
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State | AZ
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Zip | 85140-9000
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Country | US
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Telephone | 480-776-9417
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Fax | 480-907-2110
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Provider Business Mailing Address
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Address Line | 5330 E SKYLINE DR
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City | SAN TAN VALLEY
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State | AZ
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Zip | 85140-9023
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Country | US
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Telephone | 480-776-9417
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Fax | 323-313-0317
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Authorized Official
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Title or Position | CEO
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Name | HUMBERTO ROBERT INZUNZA
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Credential | PHYSICIAN ASSISTANT
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Telephone | 480-776-9417
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174H00000X
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Taxonomy Name | Health Educator
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License Number |
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License Number State |
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Taxonomy #2
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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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Taxonomy #3
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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