Provider Demographics
NPI:1114144771
Name:ALBERTI-CORREA FAMILY MEDICINE, PC
Entity Type:Organization
Organization Name:ALBERTI-CORREA FAMILY MEDICINE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:ALBERTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-649-6477
Mailing Address - Street 1:450 S WILLARD ST
Mailing Address - Street 2:SUITE 120
Mailing Address - City:COTTONWOOD
Mailing Address - State:AZ
Mailing Address - Zip Code:86326-6743
Mailing Address - Country:US
Mailing Address - Phone:928-649-6477
Mailing Address - Fax:928-649-2719
Practice Address - Street 1:450 S WILLARD ST
Practice Address - Street 2:SUITE 120
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326-6743
Practice Address - Country:US
Practice Address - Phone:928-649-6477
Practice Address - Fax:928-649-2719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTC3459261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ63328Medicare ID - Type Unspecified