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General NPI Number Information
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NPI Number | 1609921378
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Entity Type | Organization
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Legal Business Name | GILA INTERNAL MEDICINE & GERIATRIC P C
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Dates
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Enumeration Date | 01/24/2007
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Last Update Date | 08/12/2024
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Provider Practice Location Address
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Address Line | 2727 W BASELINE RD. SUITE 8
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City | TEMPE
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State | AZ
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Zip | 85283-1068
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Country | US
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Telephone | 602-323-0904
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Fax | 602-243-7616
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Provider Business Mailing Address
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Address Line | 2727 W. BASELINE RD. SUITE 8
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City | TEMPE
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State | AZ
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Zip | 85283-1068
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Country | US
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Telephone | 602-323-0904
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Fax | 602-243-7616
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Authorized Official
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Title or Position | MD/OWNER
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Name | DR. AURELIANO E CIFUENTES
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Credential | MD
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Telephone | 602-323-0904
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | 11483
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License Number State | AZ
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