Provider Demographics
NPI:1932469343
Name:REGENT PHYSICIANS OF ARIZONA, PLLC
Entity Type:Organization
Organization Name:REGENT PHYSICIANS OF ARIZONA, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LEONARDO
Authorized Official - Middle Name:C
Authorized Official - Last Name:SERFINO
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:520-220-5711
Mailing Address - Street 1:1951 N WILMOT RD
Mailing Address - Street 2:BLDG 1, STE 2
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-8000
Mailing Address - Country:US
Mailing Address - Phone:520-722-3777
Mailing Address - Fax:520-296-6224
Practice Address - Street 1:1590 PASEO SAN LUIS
Practice Address - Street 2:101
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-4782
Practice Address - Country:US
Practice Address - Phone:520-220-5711
Practice Address - Fax:520-220-5709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-18
Last Update Date:2014-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ30887207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ736598Medicaid
AZZ154087Medicare PIN
AZ736598Medicaid