MEDICARE: BROCA HEALTH LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	302R00000X	Health Maintenance Organization	29743	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	825512	OTHER	AZ	AETNA GROUP #
2	9656031	OTHER	AZ	CIGNA #
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	1583670	OTHER	AZ	UNITED HEALTHCARE #
5	2Z2152	OTHER	AZ	HEALTHNET #
6	3267734	OTHER	AZ	AETNA PROVIDER #
7	7910494	OTHER	AZ	AETNA PIN #
8	AZ0767110	OTHER	AZ	BCBSAZ #

General Provider Information

NPI Number	:	1104045830
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BROCA HEALTH LLC

Provider Business Mailing Address
First Line	:	3941 E CHANDLER BLVD
Second Line	:	STE. 106-158
City	:	PHOENIX
State	:	AZ
Zip	:	85048-0301
Country	:	US
Telephone Number	:	480-557-5710
Fax Number	:	480-557-5712

Provider Business Practice Location Address
First Line	:	1492 S MILL AVE
Second Line	:	STE. 114
City	:	TEMPE
State	:	AZ
Zip	:	85281-5652
Country	:	US
Telephone Number	:	480-557-5710
Fax Number	:	480-557-5712

Authorized Official
Title or Position	:	DOCTOR
Name	:	IGNACIO CABEZUDO
Credential	:	MD
Telephone Number	:	480-557-5710

Provider Enumeration Date	:	04/24/2007
Last Update Date	:	06/02/2010

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Directions to “BROCA HEALTH LLC ” Practice Location

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