1548483530 NPI number — SONCEREA TRILL SWIFT FP

Table of content: SONCEREA TRILL SWIFT FP (NPI 1548483530)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548483530 NPI number — SONCEREA TRILL SWIFT FP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SWIFT
Provider First Name:
SONCEREA
Provider Middle Name:
TRILL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SWIFT
Provider Other First Name:
SONCERIA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
FP
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1548483530
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/22/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9737 W RUNION DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PEORIA
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85382-2289
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-669-7151
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4521 W MAGDALENA LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAVEEN
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85339-2351
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-709-8828
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/10/2007

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: 104100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 104100000X , with the licence number: 11066 , 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)

  • Identifier: 101552 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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