Provider Demographics
NPI:1265610794
Name:CIAO BELLA MEDICAL SPA & VEIN CLINIC, P.L.C.
Entity type:Organization
Organization Name:CIAO BELLA MEDICAL SPA & VEIN CLINIC, P.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EDGARDO
Authorized Official - Middle Name:DONATO
Authorized Official - Last Name:ZAVALA-ALARCON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-686-8177
Mailing Address - Street 1:2310 W RAY RD
Mailing Address - Street 2:STE 1
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-3516
Mailing Address - Country:US
Mailing Address - Phone:480-686-8177
Mailing Address - Fax:480-686-8425
Practice Address - Street 1:2310 W RAY RD
Practice Address - Street 2:SUITE 1
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-3516
Practice Address - Country:US
Practice Address - Phone:480-686-8177
Practice Address - Fax:480-686-8425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-06
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ27016202K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes202K00000XAllopathic & Osteopathic PhysiciansPhlebologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ113861Medicare PIN