Provider Demographics
NPI:1265523765
Name:COMPREHENSIVE MEDICAL CARE PC
Entity type:Organization
Organization Name:COMPREHENSIVE MEDICAL CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YURI
Authorized Official - Middle Name:
Authorized Official - Last Name:TALALAEV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-393-0898
Mailing Address - Street 1:17450 S LA CANADA DR
Mailing Address - Street 2:
Mailing Address - City:SAHUARITA
Mailing Address - State:AZ
Mailing Address - Zip Code:85629-9718
Mailing Address - Country:US
Mailing Address - Phone:520-393-0898
Mailing Address - Fax:520-393-1750
Practice Address - Street 1:17450 S LA CANADA DR
Practice Address - Street 2:
Practice Address - City:SAHUARITA
Practice Address - State:AZ
Practice Address - Zip Code:85629-9718
Practice Address - Country:US
Practice Address - Phone:520-393-0898
Practice Address - Fax:520-393-1750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2009-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ28484261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ74622Medicare PIN