Provider Demographics
NPI:1700992260
Name:MT MORIAH MEDICAL CENTER PC
Entity Type:Organization
Organization Name:MT MORIAH MEDICAL CENTER PC
Other - Org Name:MT MORIAH MEDICAL CLINIC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:NALLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-426-1034
Mailing Address - Street 1:1828 E FLORENCE BLVD
Mailing Address - Street 2:#A111
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85222-4783
Mailing Address - Country:US
Mailing Address - Phone:520-426-1034
Mailing Address - Fax:520-423-3810
Practice Address - Street 1:1828 E FLORENCE BLVD
Practice Address - Street 2:#A111
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85222-4783
Practice Address - Country:US
Practice Address - Phone:520-426-1034
Practice Address - Fax:520-423-3810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty