Organization
SOUTHWEST DIABETES CENTER PLLC
Active
Organization
SOUTHWEST DIABETES CENTER PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SERGIO PENAHERRERA MD (OWNER)
(928) 344-6450
Entity
Organization
Contact information
Practice address
3800 W 24TH ST, 1, YUMA, AZ 85364-6298
(928) 344-6450
(928) 344-6480
Mailing address
PO BOX 590, YUMA, AZ 85366-0590
(928) 344-6450
(928) 344-6480
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
167090003
—
AZ
Enumeration date
11/01/2006
Last updated
08/15/2013
Update your record
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