Provider Demographics
NPI:1952352585
Name:RAMON C PASCUA MD PLLC
Entity Type:Organization
Organization Name:RAMON C PASCUA MD PLLC
Other - Org Name:NORTHWEST FAMILY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAMON
Authorized Official - Middle Name:
Authorized Official - Last Name:PASCUA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:623-466-6339
Mailing Address - Street 1:17100 N 67TH AVE
Mailing Address - Street 2:BUILDING 5, SUITE 502
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-3605
Mailing Address - Country:US
Mailing Address - Phone:623-466-6339
Mailing Address - Fax:623-466-6338
Practice Address - Street 1:17100 N 67TH AVE
Practice Address - Street 2:BUILDING 5, SUITE 502
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-3605
Practice Address - Country:US
Practice Address - Phone:623-466-6339
Practice Address - Fax:623-466-6338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2010-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ24918207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ374067Medicaid
AZ374067Medicaid
AZ109572Medicare PIN