| Southwest Diabetes Center Pllc | |
|
3800 W 24th St 1 Yuma AZ 85364-6298 | |
| (928) 344-6450 | |
| (928) 344-6480 |
| Full Name | Southwest Diabetes Center Pllc |
|---|---|
| Speciality | Internal Medicine |
| Location | 3800 W 24th St, Yuma, Arizona |
| Authorized Official Name and Position | Sergio Penaherrera (OWNER) |
| Authorized Official Contact | 9283446450 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southwest Diabetes Center Pllc Po Box 590 Yuma AZ 85366-0590 Ph: (928) 344-6450 | Southwest Diabetes Center Pllc 3800 W 24th St 1 Yuma AZ 85364-6298 Ph: (928) 344-6450 |
| NPI Number | 1881772317 |
|---|---|
| Provider Enumeration Date | 11/01/2006 |
| Last Update Date | 08/15/2013 |
| Medicare PECOS PAC ID | 0648255323 |
|---|---|
| Medicare Enrollment ID | O20040618001002 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881772317 | NPI | - | NPPES |
| 167090003 | Medicaid | AZ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Jane J Ramirez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548765951 PECOS PAC ID: 8123381548 Enrollment ID: I20180418001219 |
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