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General NPI Number Information
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NPI Number | 1790976470
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Entity Type | Organization
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Legal Business Name | FLAGSTAFF FAMILY PHYSICIANS PC
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Dates
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Enumeration Date | 08/07/2007
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Last Update Date | 09/02/2023
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Provider Practice Location Address
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Address Line | 710 N BEAVER ST STE 3
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City | FLAGSTAFF
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State | AZ
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Zip | 86001-3100
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Country | US
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Telephone | 928-226-1454
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Fax | 928-226-1461
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Provider Business Mailing Address
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Address Line | 710 N BEAVER ST STE 3
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City | FLAGSTAFF
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State | AZ
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Zip | 86001-3100
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Country | US
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Telephone | 928-226-1454
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Fax | 928-226-1461
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Authorized Official
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Title or Position | REGIONAL MANAGER
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Name | EMILY CASTILLO
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Credential |
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Telephone | 702-480-2550
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 27015
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License Number State | AZ
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