| Phoenix West Internal Medicine Llc | |
|
4150 N 108th Ave Ste 142 Phoenix AZ 85037-5467 | |
| (623) 322-1145 | |
| (623) 466-9552 |
| Full Name | Phoenix West Internal Medicine Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 4150 N 108th Ave, Phoenix, Arizona |
| Authorized Official Name and Position | Fernando Raul De Castro (OWNER) |
| Authorized Official Contact | 6233221145 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Phoenix West Internal Medicine Llc 9524 W Camelback Rd Ste 130 Pmb186 Glendale AZ 85305-3104 Ph: (623) 322-1145 | Phoenix West Internal Medicine Llc 4150 N 108th Ave Ste 142 Phoenix AZ 85037-5467 Ph: (623) 322-1145 |
| NPI Number | 1609805530 |
|---|---|
| Provider Enumeration Date | 07/02/2006 |
| Last Update Date | 03/08/2011 |
| Medicare PECOS PAC ID | 5294733580 |
|---|---|
| Medicare Enrollment ID | O20061121000239 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609805530 | NPI | - | NPPES |
| 648735 | Medicaid | AZ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 30062 (Arizona) | Primary |
| Provider Name | Fernando Raul D De Castro |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1184617979 PECOS PAC ID: 2163452608 Enrollment ID: I20050816000021 |
| Provider Name | Antonio T Uvas |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1730109745 PECOS PAC ID: 4183690829 Enrollment ID: I20061016000144 |
| Provider Name | Katherine E Gross |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1336584184 PECOS PAC ID: 7416254164 Enrollment ID: I20190904003030 |
| Provider Name | Stefany Sheree Irizarry |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679174262 PECOS PAC ID: 2961896097 Enrollment ID: I20220306000016 |
| Provider Name | Silvia Yaneth Sanchez Cardenas |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1295299402 PECOS PAC ID: 6507210655 Enrollment ID: I20230925000274 |
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