Provider Demographics
NPI:1104865757
Name:HOPE DIABETES CENTER, LLC
Entity Type:Organization
Organization Name:HOPE DIABETES CENTER, LLC
Other - Org Name:CLINICA ESPERANZA-HOPE PRIMARY CARE, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARILEY
Authorized Official - Middle Name:M
Authorized Official - Last Name:SEGRERA-GRABANIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-497-5933
Mailing Address - Street 1:PO BOX 838
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85299-0838
Mailing Address - Country:US
Mailing Address - Phone:480-497-5933
Mailing Address - Fax:480-497-5934
Practice Address - Street 1:3048 E BASELINE RD STE 122
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-7288
Practice Address - Country:US
Practice Address - Phone:480-497-5933
Practice Address - Fax:480-497-5934
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-06
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207R00000X
AZ2409363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ110980Medicare PIN