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General NPI Number Information
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NPI Number | 1619057932
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Entity Type | Organization
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Legal Business Name | ARIZONA MEDICAL CENTER PLLC
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Dates
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Enumeration Date | 10/17/2006
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Last Update Date | 12/19/2012
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Provider Practice Location Address
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Address Line | 2095 W 24TH ST STE A
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City | YUMA
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State | AZ
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Zip | 85364-6243
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Country | US
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Telephone | 928-328-8393
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Fax |
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Provider Business Mailing Address
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Address Line | 2095 W 24TH ST STE A
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City | YUMA
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State | AZ
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Zip | 85364-6243
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Country | US
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Telephone | 928-328-8393
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. MANJUNATH NATHAN
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Credential | M.D.
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Telephone | 928-328-8393
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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 | 36116
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License Number State | AZ
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