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General NPI Number Information
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NPI Number | 1871629733
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Entity Type | Organization
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Legal Business Name | SAN PEDRO FAMILY CARE, PLC
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Dates
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Enumeration Date | 02/26/2007
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Last Update Date | 10/29/2007
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Provider Practice Location Address
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Address Line | 890 W 4TH ST
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City | BENSON
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State | AZ
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Zip | 85602-6437
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Country | US
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Telephone | 520-586-3664
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Fax | 520-586-3665
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Provider Business Mailing Address
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Address Line | 890 W 4TH ST
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City | BENSON
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State | AZ
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Zip | 85602-6437
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Country | US
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Telephone | 520-586-3664
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Fax | 520-586-3665
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Authorized Official
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Title or Position | MANAGER
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Name | JANINE F WILEY
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Credential |
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Telephone | 520-586-3664
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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 |
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License Number State |
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