1164619896 NPI number — YUMA VALLEY FAMILY MEDICINE CENTER PC

Table of content: PROF. CHARLENE JOAN SCHULZ M.S., DRPH (NPI 1023068442)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164619896 NPI number — YUMA VALLEY FAMILY MEDICINE CENTER PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
YUMA VALLEY FAMILY MEDICINE CENTER PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164619896
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/10/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 330
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YUMA
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85366-2313
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-782-1903
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2741 S 8TH AVE
Provider Second Line Business Practice Location Address:
STE B
Provider Business Practice Location Address City Name:
YUMA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85364-7154
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-782-1903
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
OCHOA
Authorized Official First Name:
RICKY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
928-782-1903

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  36865 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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