Organization
HAVASU EMERGENCY PHYSICIANS, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DEBRA A. GULYANICS D.O. (MANAGING PARTNER)
(928) 453-0150
Entity
Organization
Contact information
Practice address
101 CIVIC CENTER LN, LAKE HAVASU CITY, AZ 86403-5607
(928) 453-0150
Mailing address
PO BOX 661454, ARCADIA, CA 91066-1454
(626) 447-0296
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
423632
AHCCCS
AZ
05
—
XGG007110
—
AZ
Enumeration date
09/14/2006
Last updated
02/26/2008
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