Provider Demographics
NPI:1811139603
Name:DESERT VIEW FAMILY CLINIC CORP.
Entity type:Organization
Organization Name:DESERT VIEW FAMILY CLINIC CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:ABEL
Authorized Official - Last Name:DALOTTO
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:602-279-2400
Mailing Address - Street 1:727 E BETHANY HOME RD
Mailing Address - Street 2:SUITE A-101
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-2198
Mailing Address - Country:US
Mailing Address - Phone:602-279-2400
Mailing Address - Fax:602-279-5890
Practice Address - Street 1:727 E BETHANY HOME RD
Practice Address - Street 2:SUITE A-101
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-2198
Practice Address - Country:US
Practice Address - Phone:602-279-2400
Practice Address - Fax:602-279-5890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-25
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ416903Medicaid