Organization
ALTEA MEDICAL CLINIC PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VERNON CHAVEZ MD (OWNER)
(928) 726-2500
Entity
Organization
Contact information
Practice address
1210 W 24TH ST STE 2, YUMA, AZ 85364-6227
(928) 726-2500
(928) 726-7853
Mailing address
1210 W 24TH ST STE 2, YUMA, AZ 85364-6227
(928) 726-2500
(928) 726-7853
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
AZ
Enumeration date
05/12/2014
Last updated
05/13/2014
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