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Organization
MOTT HAVEN MEDICAL CENTER INC
Active
Organization
MOTT HAVEN MEDICAL CENTER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ZACARIA OLIVERO (CEO)
(716) 400-9169
Entity
Organization
Contact information
Practice address
2076 E PIEDMONT PL, CASA GRANDE, AZ 85122-6812
(716) 400-9169
Mailing address
2076 E PIEDMONT PL, CASA GRANDE, AZ 85122-6812
(716) 400-9169
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
207QA0401X
Addiction Medicine (Family Medicine) Physician
—
NULL
207QA0401X
Addiction Medicine (Family Medicine) Physician
—
—
207R00000X
Internal Medicine Physician
—
NULL
207R00000X
Internal Medicine Physician
—
—
208000000X
Pediatrics Physician
—
NULL
208000000X
Pediatrics Physician
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
NULL
Other
Enumeration date
09/21/2022
Last updated
09/21/2022
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