Provider Demographics
NPI:1225220221
Name:MED OFFICES OF ROB A ALFICH
Entity Type:Organization
Organization Name:MED OFFICES OF ROB A ALFICH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:AGREDASALAS
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:623-544-3522
Mailing Address - Street 1:14420 W MEEKER BLVD # 109
Mailing Address - Street 2:
Mailing Address - City:SUN CITY WEST
Mailing Address - State:AZ
Mailing Address - Zip Code:85375
Mailing Address - Country:US
Mailing Address - Phone:623-544-3522
Mailing Address - Fax:623-544-3520
Practice Address - Street 1:14420 W MEEKER BLVD STE 109
Practice Address - Street 2:
Practice Address - City:SUN CITY WEST
Practice Address - State:AZ
Practice Address - Zip Code:85375-5287
Practice Address - Country:US
Practice Address - Phone:623-544-3522
Practice Address - Fax:623-544-3520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-14
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ19453173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ68578Medicare PIN
AZF02418Medicare UPIN
AZZ68577Medicare PIN