The Amistad Clinic, PLLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

AP9557 Issued in AZ

Legal business name

THE AMISTAD CLINIC, PLLC

Practice address

100 E 24TH St Ste 3a
Yuma, AZ 85364-8619

Phone

(480) 773-8569

NPI assigned

Aug 27, 2018

Last updated

Feb 24, 2025By 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

William Bautista Amistad Jr., FNP-BCNPI 1215380969

Title

Provider

Phone

(480) 773-8569

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in AZ

Enrollment records 1

Locations

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.

• William Bautista Amistad Jr., FNP

  • Family Nurse Practitioner
  • Yuma, AZ
  • NPI 1215380969
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1535328000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1740355200000",
    "number": "1639650898",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 E 24TH ST STE 3A",
            "city": "YUMA",
            "state": "AZ",
            "postal_code": "853648619",
            "telephone_number": "928-750-6410",
            "fax_number": "928-750-6433"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 E 24TH ST STE 3A",
            "city": "YUMA",
            "state": "AZ",
            "postal_code": "853648619",
            "telephone_number": "480-773-8569"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE AMISTAD CLINIC, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-08-27",
        "last_updated": "2025-02-24",
        "certification_date": "2025-02-21",
        "status": "A",
        "authorized_official_last_name": "AMISTAD",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "BAUTISTA",
        "authorized_official_title_or_position": "PROVIDER",
        "authorized_official_telephone_number": "480-773-8569",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "FNP-BC"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AZ",
            "license": "AP9557",
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "AZ",
            "license": "AP9557",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "205215",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Nancy Jo Terry, R.N.
• Terucko PLLC
• Roza Tesfahunegn, PHARM.D
• Diana Thant, M.D.
• Rajoo Thapa, MD
• The Bone and Joint Center of Yuma, PLLC
• The Excel Group
• The Excel Group
• The Excel Group
• The Excel Group (Southwest Recovery Center)

• Primary Care Clinic/Center in Yuma, AZ
• Providers in Yuma, AZ by specialty
• Primary Care Clinic/Center in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.