| Inclusicare Medical | |
|
700 W Campbell Ave Ste 15 Phoenix AZ 85013-2691 | |
| (623) 349-1392 | |
| Not Available |
| Full Name | Inclusicare Medical |
|---|---|
| Speciality | Family Medicine |
| Location | 700 W Campbell Ave Ste 15, Phoenix, Arizona |
| Authorized Official Name and Position | Luis Carlos Gutierrez (PRESIDENT/PHYSICIAN ASSISTANT) |
| Authorized Official Contact | 6238731200 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Inclusicare Medical 700 W Campbell Ave Ste 15 Phoenix AZ 85013-2691 | Inclusicare Medical 700 W Campbell Ave Ste 15 Phoenix AZ 85013-2691 Ph: (623) 349-1392 |
| NPI Number | 1811777568 |
|---|---|
| Provider Enumeration Date | 10/02/2023 |
| Last Update Date | 04/04/2024 |
| Certification Date | 04/04/2024 |
| Medicare PECOS PAC ID | 9133575103 |
|---|---|
| Medicare Enrollment ID | O20231026003826 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811777568 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (NU) | Primary |
| 261Q00000X | Clinic/center | (NU) | Secondary |
| Provider Name | Luis Carlos Gutierrez |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1295106391 PECOS PAC ID: 7618277427 Enrollment ID: I20151201001381 |
| Provider Name | Martita Marcano Perez |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1275812901 PECOS PAC ID: 0143575290 Enrollment ID: I20180614000364 |
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