Provider Demographics
NPI:1538941166
Name:AFCC MEDICAL CENTER LLC
Entity type:Organization
Organization Name:AFCC MEDICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:GUSTAVO
Authorized Official - Middle Name:E
Authorized Official - Last Name:DALOTTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-989-5550
Mailing Address - Street 1:1310 N 24TH ST
Mailing Address - Street 2:#150A
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85008
Mailing Address - Country:US
Mailing Address - Phone:602-254-0200
Mailing Address - Fax:602-254-0237
Practice Address - Street 1:1310 N 24TH ST
Practice Address - Street 2:#150A
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85008-4617
Practice Address - Country:US
Practice Address - Phone:602-254-0200
Practice Address - Fax:602-254-0237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-18
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty