# MOTT HAVEN MEDICAL CENTER INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1194448498
- **Authorized official:** ZACARIA OLIVERO (CEO)
- **Authorized official phone:** (716) 400-9169

## Contact information

- **Practice address:** 2076 E PIEDMONT PL, CASA GRANDE, AZ 85122-6812
- **Practice address phone:** (716) 400-9169
- **Mailing address:** 2076 E PIEDMONT PL, CASA GRANDE, AZ 85122-6812
- **Mailing address phone:** (716) 400-9169

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 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