Provider Demographics
NPI:1215101506
Name:IUVENESCO, P.C.
Entity type:Organization
Organization Name:IUVENESCO, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:FERNANDO
Authorized Official - Middle Name:A
Authorized Official - Last Name:FELIX
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:520-398-2773
Mailing Address - Street 1:PO BOX 4197
Mailing Address - Street 2:
Mailing Address - City:TUBAC
Mailing Address - State:AZ
Mailing Address - Zip Code:85646-4197
Mailing Address - Country:US
Mailing Address - Phone:520-398-2773
Mailing Address - Fax:
Practice Address - Street 1:17 CALLE BACA
Practice Address - Street 2:
Practice Address - City:TUBAC
Practice Address - State:AZ
Practice Address - Zip Code:85646
Practice Address - Country:US
Practice Address - Phone:520-398-2773
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-17
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7182111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ101581Medicare PIN