Provider Demographics
NPI:1396978268
Name:YOUNG HEARTS OF YUMA, INC
Entity type:Organization
Organization Name:YOUNG HEARTS OF YUMA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MAHER
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:AWAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-317-1119
Mailing Address - Street 1:2051 W 25TH ST
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-6912
Mailing Address - Country:US
Mailing Address - Phone:928-317-1119
Mailing Address - Fax:928-344-2270
Practice Address - Street 1:2051 W 25TH ST
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-6912
Practice Address - Country:US
Practice Address - Phone:928-317-1119
Practice Address - Fax:928-344-2270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-26
Last Update Date:2009-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZH80872Medicare UPIN