Provider Demographics
NPI:1629525191
Name:ORNELAS INTERNAL MEDICINE PLLC
Entity Type:Organization
Organization Name:ORNELAS INTERNAL MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:KATI
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:ROTHS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-717-2612
Mailing Address - Street 1:7331 E OSBORN DR STE 420
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-6415
Mailing Address - Country:US
Mailing Address - Phone:480-822-0647
Mailing Address - Fax:602-374-3450
Practice Address - Street 1:7331 E OSBORN DR STE 420
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-6415
Practice Address - Country:US
Practice Address - Phone:480-822-0647
Practice Address - Fax:602-374-3450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ46444207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty