| Pueblo Family Physicians Ltd | |
|
4350 N 19th Ave Suite 6 Phoenix AZ 85015-4602 | |
| (602) 264-9191 | |
| (602) 532-2973 |
| Full Name | Pueblo Family Physicians Ltd |
|---|---|
| Speciality | Family Medicine |
| Location | 4350 N 19th Ave, Phoenix, Arizona |
| Authorized Official Name and Position | Rick Johns (PRACTICE ADMINISTRATOR) |
| Authorized Official Contact | 6028508913 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pueblo Family Physicians Ltd 4350 N 19th Ave Ste 6 Phoenix AZ 85015-4602 Ph: (602) 850-8913 | Pueblo Family Physicians Ltd 4350 N 19th Ave Suite 6 Phoenix AZ 85015-4602 Ph: (602) 264-9191 |
| NPI Number | 1790798072 |
|---|---|
| Provider Enumeration Date | 08/15/2006 |
| Last Update Date | 02/09/2024 |
| Certification Date | 02/09/2024 |
| Medicare PECOS PAC ID | 2062497936 |
|---|---|
| Medicare Enrollment ID | O20040623001193 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790798072 | NPI | - | NPPES |
| 423779 | Medicaid | AZ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 2325 (Arizona) | Primary |
| Provider Name | Donald G Cunningham |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1508855719 PECOS PAC ID: 0345296943 Enrollment ID: I20100308000790 |
| Provider Name | Douglas L Cunningham |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1104856475 PECOS PAC ID: 8123142072 Enrollment ID: I20100828000131 |
| Provider Name | Deborah R Locke |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1942637103 PECOS PAC ID: 3375773955 Enrollment ID: I20140226001764 |
| Provider Name | Scott Sabish |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497128680 PECOS PAC ID: 9638102882 Enrollment ID: I20151214002608 |
| Provider Name | Thomas Sirrine |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1689900276 PECOS PAC ID: 9931488780 Enrollment ID: I20161117002593 |
| Provider Name | Phillip Steven Prusinski |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033661244 PECOS PAC ID: 3274807581 Enrollment ID: I20171017000739 |
| Provider Name | Alfredo M Flores |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750913810 PECOS PAC ID: 6002245537 Enrollment ID: I20200406000449 |
| Provider Name | Patricia Li |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003579830 PECOS PAC ID: 5698165983 Enrollment ID: I20211130002597 |
| Provider Name | Adam Esquer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073476032 PECOS PAC ID: 4082191135 Enrollment ID: I20260121001334 |
| Provider Name | Carlos Armando Perez |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1457245953 PECOS PAC ID: 1557848520 Enrollment ID: I20260121002039 |
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