Arizona State Internal Medicine Associates PLLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

29006 Issued in AZ

Legal business name

ARIZONA STATE INTERNAL MEDICINE ASSOCIATES PLLC

Practice address

17100 N 67TH Ave
Suite 401
Glendale, AZ 85308-3605

Phone

(602) 795-8698

Fax

(602) 795-8699

NPI assigned

Oct 25, 2012

Last updated

Oct 25, 2012By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Leticia Gangan Jacinto, MDNPI 1043210198

Title

President

Phone

(602) 361-8099

Specialties & licenses 1

Addresses

Practitioners 1

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.

• Leticia G Jacinto, M.D.

  • Child & Adolescent Psychiatry Physician
  • Glendale, AZ
  • NPI 1043210198
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1351123200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1351123200000",
    "number": "1255684437",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17100 N 67TH AVE",
            "address_2": "SUITE 401",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853083605",
            "telephone_number": "602-795-8698",
            "fax_number": "602-795-8699"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17100 N 67TH AVE",
            "address_2": "SUITE 401",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853083605",
            "telephone_number": "602-795-8698",
            "fax_number": "602-795-8699"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ARIZONA STATE INTERNAL MEDICINE ASSOCIATES PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-25",
        "last_updated": "2012-10-25",
        "status": "A",
        "authorized_official_last_name": "JACINTO",
        "authorized_official_first_name": "LETICIA",
        "authorized_official_middle_name": "GANGAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "602-361-8099",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "AZ",
            "license": "29006",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Arizona State University (Arizona State University Health Services)
• Arizona State Urology LLC
• Arizona Sunshine Assisted Living LLC
• Arizona Surgical Assistants, LLC
• Arizona Therapy Squad, LLC

• Internal Medicine Physician in Glendale, AZ
• Providers in Glendale, AZ by specialty
• Internal Medicine Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 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.

Verify at the official NPI Registry.