Provider Demographics
NPI:1609921378
Name:GILA INTERNAL MEDICINE & GERIATRIC P C
Entity Type:Organization
Organization Name:GILA INTERNAL MEDICINE & GERIATRIC P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AURELIANO
Authorized Official - Middle Name:E
Authorized Official - Last Name:CIFUENTES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-323-0904
Mailing Address - Street 1:2727 W. BASELINE RD.
Mailing Address - Street 2:SUITE 8
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-1068
Mailing Address - Country:US
Mailing Address - Phone:602-323-0904
Mailing Address - Fax:602-243-7616
Practice Address - Street 1:2727 W BASELINE RD.
Practice Address - Street 2:SUITE 8
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-1068
Practice Address - Country:US
Practice Address - Phone:602-323-0904
Practice Address - Fax:602-243-7616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11483302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ418039Medicaid
AZ1Z8080OtherHEALTHNET
AZPACIFICAREOther99545
AZ2154623OtherAETNA
AZ750125OtherHUMANA
AZ98014189OtherGREAT WEST
AZAZ0714680OtherBCBS ARIZONA
AZ0400655OtherUHC
AZ6569834003OtherCIGNA
AZZ7005Medicare ID - Type UnspecifiedMEDICARE
AZ418039Medicaid
AZ6569834003OtherCIGNA
AZ1Z8080OtherHEALTHNET