Provider Demographics
NPI:1497025399
Name:CLINICAS DEL DR. CAZARES
Entity Type:Organization
Organization Name:CLINICAS DEL DR. CAZARES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERALA MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TONI
Authorized Official - Middle Name:A
Authorized Official - Last Name:SAMANIEGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-939-1411
Mailing Address - Street 1:6717 N 59TH AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85301-3205
Mailing Address - Country:US
Mailing Address - Phone:623-939-1411
Mailing Address - Fax:623-939-1465
Practice Address - Street 1:6717 N 59TH AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85301-3205
Practice Address - Country:US
Practice Address - Phone:623-939-1411
Practice Address - Fax:623-939-1465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-09
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1700261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ213546Medicaid
AZ213546Medicaid
C99001Medicare UPIN