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General NPI Number Information
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NPI Number | 1649366378
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Entity Type | Organization
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Legal Business Name | ABAN CARE CLINIC LLC
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 07/24/2025
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Provider Practice Location Address
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Address Line | 2182 HIGHWAY 95
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City | BULLHEAD CITY
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State | AZ
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Zip | 86442-6044
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Country | US
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Telephone | 928-758-6420
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Fax | 928-758-6509
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Provider Business Mailing Address
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Address Line | PO BOX 20247
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City | BULLHEAD CITY
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State | AZ
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Zip | 86439-0247
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Country | US
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Telephone | 928-758-6420
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Fax | 928-758-6509
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Authorized Official
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Title or Position | MEMBER/PHYSICIAN
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Name | DR. GUILLERMO G ZEGARRA
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Credential | M.D.
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Telephone | 928-758-6420
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 32150
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License Number State | AZ
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