Basic Information
Provider Information
NPI: 1720449689
EntityType: 2
ReplacementNPI:  
OrganizationName: ARIZONA UROLOGY SPECIALISTS, PLLC
LastName:  
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Mailing Information
Address1: 77 E THOMAS RD STE 230
Address2:  
City: PHOENIX
State: AZ
PostalCode: 850123100
CountryCode: US
TelephoneNumber: 6025570007
FaxNumber: 6025570001
Practice Location
Address1: 1313 E OSBORN RD STE 150
Address2:  
City: PHOENIX
State: AZ
PostalCode: 850145688
CountryCode: US
TelephoneNumber: 6022644431
FaxNumber: 6022663870
Other Information
ProviderEnumerationDate: 03/18/2016
LastUpdateDate: 04/09/2019
NPIDeactivationReasonCode:  
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AuthorizedOfficialLastName: BRITO
AuthorizedOfficialFirstName: CESAR
AuthorizedOfficialMiddleName: GILBERTO
AuthorizedOfficialTitleorPosition: PRESIDENT
AuthorizedOfficialTelephone: 4806612662
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
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AuthorizedOfficialCredential: MD
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
332900000X  Y SuppliersNon-Pharmacy Dispensing Site 

ID Information
IDTypeStateIssuerDescription
40858705AZ MEDICAID


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