Provider Demographics
NPI:1386842151
Name:YUMA FAMILY PRACTICE PLC
Entity Type:Organization
Organization Name:YUMA FAMILY PRACTICE PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:AMRITA
Authorized Official - Middle Name:
Authorized Official - Last Name:DHANJAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-726-2500
Mailing Address - Street 1:1210 W 24TH ST
Mailing Address - Street 2:SUITE #2
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-6226
Mailing Address - Country:US
Mailing Address - Phone:928-726-2500
Mailing Address - Fax:928-726-7853
Practice Address - Street 1:1210 W 24TH ST
Practice Address - Street 2:SUITE #2
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-6226
Practice Address - Country:US
Practice Address - Phone:928-726-2500
Practice Address - Fax:928-726-7853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-03
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ23601Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER