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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
207QA0401X
Addiction Medicine (Family Medicine) Physician
207R00000X
Internal Medicine Physician
208000000X
Pediatrics Physician
261QM1300X
Multi-Specialty Clinic/Center

Other

Enumeration date
09/21/2022
Last updated
09/21/2022
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