Provider Demographics
NPI:1033505755
Name:ARIZONA ARTHRITIS CLINIC
Entity Type:Organization
Organization Name:ARIZONA ARTHRITIS CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:AZELEA
Authorized Official - Middle Name:
Authorized Official - Last Name:ENCISO
Authorized Official - Suffix:
Authorized Official - Credentials:AO
Authorized Official - Phone:480-582-1568
Mailing Address - Street 1:604 W WARNER RD STE C1
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-2915
Mailing Address - Country:US
Mailing Address - Phone:480-372-8200
Mailing Address - Fax:480-372-8222
Practice Address - Street 1:604 W WARNER RD STE C1
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-2915
Practice Address - Country:US
Practice Address - Phone:480-372-8200
Practice Address - Fax:480-372-8222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-09
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ092299Medicaid
1033505755OtherNPI