Provider Demographics
NPI:1932120870
Name:BRUCE E SILVA MD AND KENNETH S. KACENGA DO PLLC
Entity Type:Organization
Organization Name:BRUCE E SILVA MD AND KENNETH S. KACENGA DO PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTRACTS
Authorized Official - Prefix:
Authorized Official - First Name:SANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:KAPLAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-458-6331
Mailing Address - Street 1:155 CALLE PORTAL STE 300
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-2900
Mailing Address - Country:US
Mailing Address - Phone:520-458-8075
Mailing Address - Fax:520-458-0339
Practice Address - Street 1:155 CALLE PORTAL STE 300
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-2900
Practice Address - Country:US
Practice Address - Phone:520-458-8075
Practice Address - Fax:520-458-0339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1607207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0779520OtherBCBSAZ
AZ241977Medicaid
AZE09856Medicare UPIN
AZ241977Medicaid
AZZ104695Medicare PIN