| Clinica Medica Familiar San Gabriel, Llc | |
|
4515 S Mcclintock Dr Ste 115 Tempe AZ 85282-7381 | |
| (480) 780-0690 | |
| (480) 831-0415 |
| Full Name | Clinica Medica Familiar San Gabriel, Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 4515 S Mcclintock Dr Ste 115, Tempe, Arizona |
| Authorized Official Name and Position | Marie E Bentz (OWNER) |
| Authorized Official Contact | 7144650875 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Clinica Medica Familiar San Gabriel, Llc 4515 S Mcclintock Dr Ste 115 Tempe AZ 85282-7381 Ph: (480) 780-0690 | Clinica Medica Familiar San Gabriel, Llc 4515 S Mcclintock Dr Ste 115 Tempe AZ 85282-7381 Ph: (480) 780-0690 |
| NPI Number | 1609632298 |
|---|---|
| Provider Enumeration Date | 02/22/2024 |
| Last Update Date | 02/22/2024 |
| Medicare PECOS PAC ID | 4082053269 |
|---|---|
| Medicare Enrollment ID | O20240421000130 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609632298 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Marie Elianthe Bentz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548850134 PECOS PAC ID: 4284022534 Enrollment ID: I20211019002944 |
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