Provider Demographics
NPI:1528356441
Name:INZUNZA, HUMBERTO ROBERT (PA-C)
Entity Type:Individual
Prefix:
First Name:HUMBERTO
Middle Name:ROBERT
Last Name:INZUNZA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5116 S SALK LN
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85212-8005
Mailing Address - Country:US
Mailing Address - Phone:661-221-2552
Mailing Address - Fax:
Practice Address - Street 1:5116 S SALK LN
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85212-8005
Practice Address - Country:US
Practice Address - Phone:661-221-2552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-12
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174H00000X
AZ6604207Q00000X, 207QG0300X, 2080A0000X, 251E00000X, 261QU0200X, 363A00000X
CAPA21592363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No174H00000XOther Service ProvidersHealth Educator
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
No251E00000XAgenciesHome Health
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ254343Medicaid