NPIMap

Organization Active NPI

Clinica Dr Alfonso Salas PC

  • General Practice Physician
  • Glendale, AZ
National Provider Identifier
1265692792
Registry record updated Sep 1, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
29615 Issued in AZ
Legal business name
CLINICA DR ALFONSO SALAS PC
Practice address
7734 N 59TH Ave
Glendale, AZ 85301-7816
Phone
(623) 931-2444
Fax
(623) 931-1099
NPI assigned
Jun 9, 2008
Last updated
Sep 1, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 1, 2011

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

Authorized official

Name
Mrs. Jannet Decardenas
Title
Billing Manager
Phone
(480) 897-1175

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X 29615 AZ Primary

Addresses

Primary practice location

7734 N 59TH Ave
Glendale, AZ 85301-7816

Mailing address

PO Box 355
Glendale, AZ 85311-0355
Phone (623) 931-2444

Other identifiers 5

IdentifierTypeStateIssuer
587766MedicaidAZ
000083MedicaidAZ
616245MedicaidAZ
173414MedicaidAZ
560337MedicaidAZ

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1212969600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1314835200000",
    "number": "1265692792",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 355",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853110355",
            "telephone_number": "623-931-2444",
            "fax_number": "623-931-1099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7734 N 59TH AVE",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853017816",
            "telephone_number": "623-931-2444",
            "fax_number": "623-931-1099"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLINICA DR ALFONSO SALAS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-09",
        "last_updated": "2011-09-01",
        "status": "A",
        "authorized_official_last_name": "DECARDENAS",
        "authorized_official_first_name": "JANNET",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "480-897-1175",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "AZ",
            "license": "29615",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "587766",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000083",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "616245",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "173414",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "560337",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Glendale, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2011; 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.