Provider Demographics
NPI:1033342027
Name:RTOPETE LLC
Entity Type:Organization
Organization Name:RTOPETE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:REYES
Authorized Official - Middle Name:R
Authorized Official - Last Name:TOPETE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-250-8559
Mailing Address - Street 1:3145 E CHANDLER BLVD STE 110
Mailing Address - Street 2:PMB 437
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85048-8702
Mailing Address - Country:US
Mailing Address - Phone:480-250-8559
Mailing Address - Fax:480-460-2972
Practice Address - Street 1:1943 E BROOKWOOD CT
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85048-4233
Practice Address - Country:US
Practice Address - Phone:480-250-8559
Practice Address - Fax:480-460-2972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-25
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ22381207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZL-0959217-9OtherCORPORATION NUMBER