Provider Demographics
NPI:1245291392
Name:AFFILIATED GENERAL SURGEON II PC
Entity type:Organization
Organization Name:AFFILIATED GENERAL SURGEON II PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AGUSTO
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:TORAYA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:623-846-7608
Mailing Address - Street 1:4550 N 51ST AVE
Mailing Address - Street 2:SUITE #65
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85031
Mailing Address - Country:US
Mailing Address - Phone:623-846-7608
Mailing Address - Fax:623-848-9572
Practice Address - Street 1:4550 N 51ST AVE
Practice Address - Street 2:SUITE #65
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85031
Practice Address - Country:US
Practice Address - Phone:623-846-7608
Practice Address - Fax:623-848-9572
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5663208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ220450Medicaid
AZ220450Medicaid