Organization Name: | ABAN CARE CLINIC LLC |
NPI Number: | 1649366378 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | GUILLERMO G ZEGARRA (MEMBER/PHYSICIAN) |
Mailing Address: | 2182 Highway 95 Bullhead City |
State: | AZ US |
Postal Code: | 864426044 |
Phone Number: | 9287586420 |
Fax Number: | 9287586509 |
NPI Enumeration Date: | 10/04/2006 |
NPI Last Update Date: | 08/29/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | 32150 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AZ |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |