Provider Demographics
NPI:1730697483
Name:CARELON MEDICAL PARTNERS OF ARIZONA, P.C.
Entity type:Organization
Organization Name:CARELON MEDICAL PARTNERS OF ARIZONA, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:ABLION
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:224-234-5025
Mailing Address - Street 1:12900 PARK PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-9329
Mailing Address - Country:US
Mailing Address - Phone:562-622-2950
Mailing Address - Fax:562-977-6141
Practice Address - Street 1:512 W ROSEDALE ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4619
Practice Address - Country:US
Practice Address - Phone:817-289-8300
Practice Address - Fax:817-289-8263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-16
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X, 207Q00000X
DC207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty