1508911710 NPI number — MR. RICHARD A AYIYI SR. CEO

Table of content: MR. RICHARD A AYIYI SR. CEO (NPI 1508911710)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508911710 NPI number — MR. RICHARD A AYIYI SR. CEO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AYIYI
Provider First Name:
RICHARD
Provider Middle Name:
A
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
SR.
Provider Credential Text:
CEO
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WINDHAM
Provider Other First Name:
JACK
Provider Other Middle Name:
G
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
GENERAL MANAGER
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1508911710
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5270 N 59TH AVE
Provider Second Line Business Mailing Address:
SUITE 18
Provider Business Mailing Address City Name:
GLENDALE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85301-6762
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
623-934-5291
Provider Business Mailing Address Fax Number:
623-847-9898

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5270 N 59TH AVE
Provider Second Line Business Practice Location Address:
SUITE 18
Provider Business Practice Location Address City Name:
GLENDALE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85301-6762
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-934-5291
Provider Business Practice Location Address Fax Number:
623-847-9898
Provider Enumeration Date:
01/25/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  D6399 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)