Provider Demographics
NPI:1578196606
Name:ROBERT INZUNZA LLC
Entity Type:Organization
Organization Name:ROBERT INZUNZA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO / PA-C
Authorized Official - Prefix:
Authorized Official - First Name:HUMBERTO
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:INZUNZA
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:661-221-2552
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:323-313-0317
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:323-313-0317
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROBERT INZUNZA LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-02-18
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
No251300000XAgenciesLocal Education Agency (LEA)
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ254343Medicaid