Provider Demographics
NPI:1730309717
Name:FOOTHILLS WALKIN MEDICAL
Entity Type:Organization
Organization Name:FOOTHILLS WALKIN MEDICAL
Other - Org Name:LEVEL 4 INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PA-C
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANA
Authorized Official - Middle Name:CECILIA
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:928-345-2150
Mailing Address - Street 1:11274 S FORTUNA RD
Mailing Address - Street 2:SUITE I-4
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85367-7847
Mailing Address - Country:US
Mailing Address - Phone:928-345-2150
Mailing Address - Fax:928-345-2151
Practice Address - Street 1:11274 S FORTUNA RD
Practice Address - Street 2:SUITE I-4
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85367-7847
Practice Address - Country:US
Practice Address - Phone:928-345-2150
Practice Address - Fax:928-345-2151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3278173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty