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General NPI Number Information
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NPI Number | 1760116487
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Entity Type | Organization
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Legal Business Name | AZ COMMUNITY CARE
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Dates
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Enumeration Date | 07/11/2022
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Last Update Date | 07/11/2022
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Provider Practice Location Address
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Address Line | 1225 HANCOCK RD STE 203
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City | BULLHEAD CITY
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State | AZ
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Zip | 86442-5962
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Country | US
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Telephone | 928-224-0064
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Fax | 480-842-8608
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Provider Business Mailing Address
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Address Line | 967 HANCOCK RD STE 133
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City | BULLHEAD CITY
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State | AZ
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Zip | 86442-5142
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Country | US
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Telephone | 928-224-0064
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Fax | 480-842-8608
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Authorized Official
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Title or Position | COO
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Name | BRIANDA SERRANO
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Credential |
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Telephone | 928-224-0064
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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 |
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License Number State |
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