Active NPI
Centro Medico del Valle PC
- Family Medicine Physician
- Phoenix, AZ
National Provider Identifier
1205160355
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 35764
- Legal business name
- CENTRO MEDICO DEL VALLE PC
- Practice address
- 2929 N 75TH Ave
Suite 5
Phoenix, AZ 85033-5400 - Phone
- (623) 873-1200
- Fax
- (623) 873-1300
- NPI assigned
- Sep 22, 2009
- Last updated
- Feb 17, 2012
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Enrique S Lopez, MD
- Title
- Owner
- Phone
- (623) 873-1200
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 35764 | AZ | Primary |
Addresses
Primary practice location
2929 N 75TH Ave
Suite 5
Phoenix, AZ 85033-5400
Mailing address
2929 N 75TH Ave
Suite 5
Phoenix, AZ 85033-5400
Phone (623) 873-1200
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 462677 | Medicaid | AZ |
National Provider Directory
National Provider DirectoryLocations
2929 N 75th Ave
Ste 5
Phoenix, AZ 85033
Phone (623) 873-1200
Practitioners & affiliated clinicians
Practitioners 4
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- Physician Assistant
- Phoenix, AZ
- NPI 1164649141
-
- Physician Assistant
- Salt Lake City, UT
- NPI 1487924486
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1253577600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1329436800000",
"number": "1205160355",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2929 N 75TH AVE",
"address_2": "SUITE 5",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850335400",
"telephone_number": "623-873-1200",
"fax_number": "623-873-1300"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2929 N 75TH AVE",
"address_2": "SUITE 5",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850335400",
"telephone_number": "623-873-1200",
"fax_number": "623-873-1300"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "CENTRO MEDICO DEL VALLE PC",
"organizational_subpart": "NO",
"enumeration_date": "2009-09-22",
"last_updated": "2012-02-17",
"status": "A",
"authorized_official_last_name": "LOPEZ",
"authorized_official_first_name": "ENRIQUE",
"authorized_official_middle_name": "S",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "623-873-1200",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Family Medicine",
"state": "AZ",
"license": "35764",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "462677",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Phoenix, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.