Provider Demographics
NPI:1215594809
Name:DELEONGUERRERO OBGYN, PLLC
Entity Type:Organization
Organization Name:DELEONGUERRERO OBGYN, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:CASEY
Authorized Official - Middle Name:
Authorized Official - Last Name:DELEONGUERRERO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:928-779-1162
Mailing Address - Street 1:1100 N. SAN FRANCISCO ST
Mailing Address - Street 2:STE B
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-3200
Mailing Address - Country:US
Mailing Address - Phone:928-779-1162
Mailing Address - Fax:928-779-1163
Practice Address - Street 1:1100 N. SAN FRANCISCO ST
Practice Address - Street 2:STE B
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-3200
Practice Address - Country:US
Practice Address - Phone:928-779-1162
Practice Address - Fax:928-779-1163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-20
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty