1790867349 NPI number — MS. DALISA BARQUERO ARNP

Table of content: MS. DALISA BARQUERO ARNP (NPI 1790867349)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790867349 NPI number — MS. DALISA BARQUERO ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BARQUERO
Provider First Name:
DALISA
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
ARNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1790867349
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/26/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
303 E BASELINE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85042-6530
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-243-7277
Provider Business Mailing Address Fax Number:
602-276-4427

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
303 E BASELINE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85042-6530
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-243-7277
Provider Business Practice Location Address Fax Number:
602-276-4427
Provider Enumeration Date:
10/20/2006

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: 163W00000X , with the licence number:  146353 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163W00000X , with the licence number: NP 06743 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: RN60740487 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: AP60740488 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LW0102X , with the licence number: AP2749 , 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: 274767 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".