GRAND CANYON MEDICAL CLINIC PLLC NPI 1164141065

NPI Information

NPI: 1164141065
Provider Name: GRAND CANYON MEDICAL CLINIC PLLC
Classification: Nurse Practitioner - 363LF0000X
Entity Type: Organization

Specialization: Family

CLIA Number: 03D2293260

Address:
1841 W 25TH ST STE B
YUMA, AZ
ZIP 85364
Phone: (928) 503-7246
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GRAND CANYON MEDICAL CLINIC PLLC is a family nurse practitioner in Yuma, AZ. GRAND CANYON MEDICAL CLINIC PLLC NPI is 1164141065. The provider is registered as an organization entity type.

The provider's business location address is:

1841 W 25TH ST STE B
YUMA, AZ
ZIP 85364-931
Phone: (928) 503-7246

The provider's authorized official is Alex D Galvez .
The authorized official title is Owner and has the following contact phone number (928) 350-8507.

The CLIA number assigned to this NPI record is 03D2293260 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 8/24/2022 and was last updated on 2/20/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261Q00000X	Clinic/Center				No
2	363LF0000X	Nurse Practitioner	Family			Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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