Organization
CENTRAL MOHAVE MEDICAL CLINICS LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL MASTAKAS M.D. (PHYSICIAN)
(928) 753-6668
Entity
Organization
Contact information
Practice address
1915 N STOCKTON HILL RD, KINGMAN, AZ 86401-4652
(928) 753-6668
(928) 753-9797
Mailing address
1915 STOCKTON HILL RD, KINGMAN, AZ 86401-4652
(928) 753-6668
(928) 753-9797
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
13105
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
217209
—
AZ
Enumeration date
05/15/2007
Last updated
09/17/2009
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