Provider Demographics
NPI:1720449689
Name:ARIZONA UROLOGY SPECIALISTS, PLLC
Entity Type:Organization
Organization Name:ARIZONA UROLOGY SPECIALISTS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CESAR
Authorized Official - Middle Name:GILBERTO
Authorized Official - Last Name:BRITO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-661-2662
Mailing Address - Street 1:77 E THOMAS RD STE 230
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-3100
Mailing Address - Country:US
Mailing Address - Phone:602-557-0007
Mailing Address - Fax:602-557-0001
Practice Address - Street 1:1313 E OSBORN RD STE 150
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-5688
Practice Address - Country:US
Practice Address - Phone:602-264-4431
Practice Address - Fax:602-266-3870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-18
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ408587Medicaid
AZ408587Medicaid