Organization
PHOENIX WEST INTERNAL MEDICINE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FERNANDO RAUL DE CASTRO M.D. (OWNER)
(623) 322-1145
Entity
Organization
Contact information
Practice address
4150 N 108TH AVE, STE 142, PHOENIX, AZ 85037-5467
(623) 322-1145
(623) 466-9552
Mailing address
9524 W CAMELBACK RD, STE 130 PMB186, GLENDALE, AZ 85305-3104
(623) 322-1145
(623) 466-9552
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
30062
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
648735
—
AZ
Enumeration date
07/02/2006
Last updated
03/08/2011
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