| Gratitude Medical Center Pllc | |
|
1310 N 24th St # 150a Phoenix AZ 85008-4617 | |
| (602) 989-5550 | |
| Not Available |
| Full Name | Gratitude Medical Center Pllc |
|---|---|
| Speciality | Counselor |
| Location | 1310 N 24th St # 150a, Phoenix, Arizona |
| Authorized Official Name and Position | Gustavo E Dalotto (OWNER) |
| Authorized Official Contact | 6029895550 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gratitude Medical Center Pllc 1310 N 24th St # 150a Phoenix AZ 85008-4617 Ph: (602) 989-5550 | Gratitude Medical Center Pllc 1310 N 24th St # 150a Phoenix AZ 85008-4617 Ph: (602) 989-5550 |
| NPI Number | 1972335891 |
|---|---|
| Provider Enumeration Date | 08/19/2024 |
| Last Update Date | 10/08/2025 |
| Certification Date | 10/08/2025 |
| Medicare PECOS PAC ID | 2961933023 |
|---|---|
| Medicare Enrollment ID | O20241001001820 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972335891 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Secondary |
| Provider Name | Long H.t. Le |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1336451525 PECOS PAC ID: 0345474227 Enrollment ID: I20150513000515 |
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