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General NPI Number Information
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NPI Number | 1851651079
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Entity Type | Organization
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Legal Business Name | COMMUNITY INTERVENTION ASSOCIATES, INC.
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Dates
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Enumeration Date | 05/22/2012
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Last Update Date | 07/31/2024
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Provider Practice Location Address
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Address Line | 2851 S. AVE B BLDG 29A SUITE 2902
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City | YUMA
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State | AZ
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Zip | 85364
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Country | US
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Telephone | 928-304-7729
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Fax | 928-344-5577
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Provider Business Mailing Address
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Address Line | 2851 S. AVE B BLDG 4
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City | YUMA
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State | AZ
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Zip | 85364
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Country | US
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Telephone | 928-376-0026
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Fax | 928-782-2298
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Authorized Official
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Title or Position | CEO
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Name | MR. ALLISON S NICOL
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Credential |
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Telephone | 928-376-0026
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | OTC-6468
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License Number State | AZ
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