Provider Demographics
NPI:1366647158
Name:DESERT HILLS FAMILY MEDICINE PC
Entity Type:Organization
Organization Name:DESERT HILLS FAMILY MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:F
Authorized Official - Last Name:RAYNAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-547-8184
Mailing Address - Street 1:20325 N. 51ST AVENUE
Mailing Address - Street 2:BLDG 9, #170
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-5674
Mailing Address - Country:US
Mailing Address - Phone:602-296-4231
Mailing Address - Fax:
Practice Address - Street 1:20325 N. 51ST AVENUE
Practice Address - Street 2:BLDG 9, #170
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-5674
Practice Address - Country:US
Practice Address - Phone:602-296-4231
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-20
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ13497207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ64492Medicare ID - Type Unspecified
AZD37496Medicare UPIN