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General NPI Number Information
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NPI Number | 1669883864
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Entity Type | Organization
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Legal Business Name | ALTEA MEDICAL CLINIC PLLC
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Dates
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Enumeration Date | 05/12/2014
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Last Update Date | 05/13/2014
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Provider Practice Location Address
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Address Line | 1210 W 24TH ST STE 2
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City | YUMA
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State | AZ
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Zip | 85364-6227
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Country | US
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Telephone | 928-726-2500
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Fax | 928-726-7853
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Provider Business Mailing Address
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Address Line | 1210 W 24TH ST STE 2
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City | YUMA
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State | AZ
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Zip | 85364-6227
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Country | US
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Telephone | 928-726-2500
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Fax | 928-726-7853
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Authorized Official
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Title or Position | OWNER
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Name | VERNON CHAVEZ
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Credential | MD
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Telephone | 928-726-2500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number |
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License Number State |
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