Provider Demographics
NPI:1548830789
Name:CHRISTIAN CARE MEDICAL FOUNDATION
Entity type:Organization
Organization Name:CHRISTIAN CARE MEDICAL FOUNDATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:HUMBERTO
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:INZUNZA
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICIAN ASSISTANT
Authorized Official - Phone:480-776-9417
Mailing Address - Street 1:5330 E SKYLINE DR
Mailing Address - Street 2:
Mailing Address - City:SAN TAN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85140-9023
Mailing Address - Country:US
Mailing Address - Phone:480-776-9417
Mailing Address - Fax:323-313-0317
Practice Address - Street 1:5418 E SKYLINE DR
Practice Address - Street 2:
Practice Address - City:SAN TAN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85140-9000
Practice Address - Country:US
Practice Address - Phone:480-776-9417
Practice Address - Fax:480-907-2110
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHRISTIAN CARE MEDICAL FOUNDATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-06-29
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty
No174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1952532988OtherSUNIL R KURUP MD NPI
AZ254343Medicaid
CA1528356441OtherHUMBERTO R INZUNZA PA-C NPI