Desert Senita Community Health Center | |
410 N Malacate St Ajo AZ 85321-2254 | |
(520) 387-5651 | |
(520) 387-5347 |
Full Name | Desert Senita Community Health Center |
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Speciality | Clinic/Center |
Location | 410 N Malacate St, Ajo, Arizona |
Authorized Official Name and Position | Daniel Barbara (CHIEF EXECUTIVE OFFICER) |
Authorized Official Contact | 5203875651 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Desert Senita Community Health Center 410 N Malacate St Ajo AZ 85321-2254 Ph: (520) 387-5651 | Desert Senita Community Health Center 410 N Malacate St Ajo AZ 85321-2254 Ph: (520) 387-5651 |
NPI Number | 1114037496 |
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Provider Enumeration Date | 08/30/2006 |
Last Update Date | 01/08/2024 |
Medicare PECOS PAC ID | 3476441866 |
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Medicare Enrollment ID | O20040308000777 |
Identifier | Type | State | Issuer |
---|---|---|---|
1114037496 | NPI | - | NPPES |
155681 | Medicaid | AZ | |
AZ0910930 | Other | AZ | BCBS |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | OTC-0274 (Arizona) | Primary |
Provider Name | Gorky Herrera |
---|---|
Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1740222025 PECOS PAC ID: 2860391638 Enrollment ID: I20031231000450 |
Provider Name | Boru M Nale |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1497949226 PECOS PAC ID: 3678521804 Enrollment ID: I20071120000344 |
Provider Name | Wen Hui Cai |
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Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1679657910 PECOS PAC ID: 1355324195 Enrollment ID: I20080813000521 |
Provider Name | Brian David Jones |
---|---|
Provider Type | Practitioner - Physical Therapist In Private Practice |
Provider Identifiers | NPI Number: 1720063282 PECOS PAC ID: 5890717771 Enrollment ID: I20100720000256 |
Provider Name | Lawrence S Kahn |
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Provider Type | Practitioner - Ophthalmology |
Provider Identifiers | NPI Number: 1083688113 PECOS PAC ID: 8921990383 Enrollment ID: I20100914001407 |
Provider Name | Scott Ellis |
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Provider Type | Practitioner - Physical Therapist In Private Practice |
Provider Identifiers | NPI Number: 1790099364 PECOS PAC ID: 1052505369 Enrollment ID: I20101101000683 |
Provider Name | Jeffrey R Lavoy |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1013002518 PECOS PAC ID: 2567643752 Enrollment ID: I20110221001052 |
Provider Name | Bernadine R Miu |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1760721161 PECOS PAC ID: 8527203108 Enrollment ID: I20130402000464 |
Provider Name | Samuel Sanchez |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1780693861 PECOS PAC ID: 2264338714 Enrollment ID: I20130724000094 |
Provider Name | Benjamin F Horberg |
---|---|
Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1073583993 PECOS PAC ID: 4082646567 Enrollment ID: I20140602001570 |
Provider Name | Thomas E Horst |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1871642082 PECOS PAC ID: 5698796480 Enrollment ID: I20160209000197 |
Provider Name | Marlene L Wilson-lavalley |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1275919698 PECOS PAC ID: 9436454741 Enrollment ID: I20160224002724 |
Provider Name | Tanya L Smith |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1184116824 PECOS PAC ID: 3779830906 Enrollment ID: I20180719001363 |
Provider Name | John E Hess |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1720171556 PECOS PAC ID: 3476645292 Enrollment ID: I20180815003141 |
Provider Name | Kelly Phelps |
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Provider Type | Practitioner - Emergency Medicine |
Provider Identifiers | NPI Number: 1831270073 PECOS PAC ID: 5294636783 Enrollment ID: I20181206003194 |
Provider Name | John Charles Sauer |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1588136998 PECOS PAC ID: 2567702665 Enrollment ID: I20190328000702 |
Provider Name | Katiria M Alvarez |
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Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
Provider Identifiers | NPI Number: 1851935787 PECOS PAC ID: 0648604751 Enrollment ID: I20191226000814 |
Provider Name | Abimbola Dtonye Iketubosin |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1356841514 PECOS PAC ID: 6709129554 Enrollment ID: I20200812001642 |
Provider Name | Briauna Ramirez |
---|---|
Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
Provider Identifiers | NPI Number: 1831760610 PECOS PAC ID: 2860880515 Enrollment ID: I20211101001830 |
Provider Name | Annabel Owusu |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1588975452 PECOS PAC ID: 4284039678 Enrollment ID: I20230530000260 |
Provider Name | Sue Moler |
---|---|
Provider Type | Practitioner - Clinical Psychologist |
Provider Identifiers | NPI Number: 1265000384 PECOS PAC ID: 0840653929 Enrollment ID: I20230823002245 |
Provider Name | Fatima Lah |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1477053338 PECOS PAC ID: 1052782224 Enrollment ID: I20231013003073 |
Provider Name | Boriana Nikolova |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1598432585 PECOS PAC ID: 3678961281 Enrollment ID: I20231026004149 |
Provider Name | Rekha Cheriyan |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1427730423 PECOS PAC ID: 2365890803 Enrollment ID: I20231122001442 |
Provider Name | Isabella Isabella Barrera |
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Provider Type | Practitioner - Mental Health Counselor |
Provider Identifiers | NPI Number: 1881989135 PECOS PAC ID: 4981055944 Enrollment ID: I20240104000981 |
Provider Name | Yvonne R Hess |
---|---|
Provider Type | Practitioner - Marriage And Family Therapist |
Provider Identifiers | NPI Number: 1104939750 PECOS PAC ID: 8325481096 Enrollment ID: I20240209000818 |
Provider Name | Michele Mitchell |
---|---|
Provider Type | Practitioner - Mental Health Counselor |
Provider Identifiers | NPI Number: 1528614757 PECOS PAC ID: 4385087766 Enrollment ID: I20240213003023 |
Provider Name | Jill R Unruh |
---|---|
Provider Type | Practitioner - Mental Health Counselor |
Provider Identifiers | NPI Number: 1316208416 PECOS PAC ID: 2365887650 Enrollment ID: I20240226004072 |
Provider Name | Yvonne Crewse |
---|---|
Provider Type | Practitioner - Mental Health Counselor |
Provider Identifiers | NPI Number: 1801074869 PECOS PAC ID: 4688093958 Enrollment ID: I20240328000032 |
Portable Practical Education Preparation Inc. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 111 La Mina Ave, Room 5, Ajo, AZ 85321 Phone: 520-387-5232 Fax: 520-387-5732 |