Individual
KENNETH KACENGA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
155 COLLE PORTAL, 300, SIERRA VISTA, AZ 85635
(520) 458-8075
(520) 458-0339
Mailing address
155 COLLE PORTAL, 300, SIERRA VISTA, AZ 85635
(520) 458-8075
(520) 458-0339
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
01607
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
241997
—
AZ
01
—
4114160
AETNA
—
01
—
AZ0779520
BCBS AZ
—
Enumeration date
06/06/2006
Last updated
01/03/2008
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