Provider Demographics
NPI:1811941321
Name:ARIZONA PREFERRED PRIMARY CARE,PLC
Entity type:Organization
Organization Name:ARIZONA PREFERRED PRIMARY CARE,PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ABED EL NASSER
Authorized Official - Middle Name:S
Authorized Official - Last Name:MOGHARBEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-736-1184
Mailing Address - Street 1:3035 S ELLSWORTH RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85212-2160
Mailing Address - Country:US
Mailing Address - Phone:480-736-1777
Mailing Address - Fax:480-736-1144
Practice Address - Street 1:3035 S ELLSWORTH RD
Practice Address - Street 2:SUITE 103
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85212
Practice Address - Country:US
Practice Address - Phone:480-736-1777
Practice Address - Fax:480-736-1144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ77747OtherMEDICARE LEGACY