| Organization Name: | GOLD CANYON FAMILY PRACTICE |
| NPI Number: | 1225337207 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DAITON RUTKOWSKI (CEO) |
| Mailing Address: | 6820 S Kings Ranch Rd Ste 130 Gold Canyon |
| State: | AZ US |
| Postal Code: | 851182959 |
| Phone Number: | 4803471321 |
| Fax Number: | 4809823692 |
| NPI Enumeration Date: | 03/16/2011 |
| NPI Last Update Date: | 09/20/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2300X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AZ |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |