Alta Medical Clinic Inc of Arizona

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

Legal business name

ALTA MEDICAL CLINIC INC OF ARIZONA

Practice address

4742 N 24TH St Ste 300
Phoenix, AZ 85016-9107

Phone

(909) 236-0338

NPI assigned

Oct 31, 2022

Organization subpart

No

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

Authorized official

Name

Peterson Go

Title

President

Phone

(909) 236-0338

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1667174400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1667174400000",
    "number": "1679280671",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4742 N 24TH ST STE 300",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850169107",
            "telephone_number": "909-236-0338"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4742 N 24TH ST STE 300",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850169107",
            "telephone_number": "909-236-0338"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALTA MEDICAL CLINIC INC OF ARIZONA",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-10-31",
        "last_updated": "2022-10-31",
        "certification_date": "2022-10-31",
        "status": "A",
        "authorized_official_last_name": "GO",
        "authorized_official_first_name": "PETERSON",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "909-236-0338"
    },
    "taxonomies": [
        {
            "code": "2084B0040X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Behavioral Neurology & Neuropsychiatry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alsham Medical PLLC
• Ahmed Alsoubaii
• Dunivah Alston-Ray, SLPA
• Crystal Alston, NP-C
• Alt Med Ctr LLC
• Amal Altaf, MD
• Misbah W. Altaf, MD
• Altalume Az, PC
• Tabarak Altameemi, RPH
• Cassandra Altamirano, PA-C

• General Practice Physician in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• General Practice Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2022; 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.