Provider Demographics
NPI:1972879773
Name:CARELON MEDICAL PARTNERS OF ARIZONA, P.C.
Entity type:Organization
Organization Name:CARELON MEDICAL PARTNERS OF ARIZONA, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:ALBION
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:224-234-5025
Mailing Address - Street 1:12900 PARK PLAZA DR
Mailing Address - Street 2:SUITE 150, MS-6165
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-9329
Mailing Address - Country:US
Mailing Address - Phone:562-741-4461
Mailing Address - Fax:562-622-2971
Practice Address - Street 1:5055 E BROADWAY BLVD
Practice Address - Street 2:SUITE 111
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-3640
Practice Address - Country:US
Practice Address - Phone:520-529-8387
Practice Address - Fax:520-844-1111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-26
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ18791207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty