1073657276 NPI number — MRS. BERTHA GONZALES SESTEAGA BACHELORS DEGREE

Table of content: MRS. BERTHA GONZALES SESTEAGA BACHELORS DEGREE (NPI 1073657276)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073657276 NPI number — MRS. BERTHA GONZALES SESTEAGA BACHELORS DEGREE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SESTEAGA
Provider First Name:
BERTHA
Provider Middle Name:
GONZALES
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
BACHELORS DEGREE
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SESTEAGA
Provider Other First Name:
BERTHA
Provider Other Middle Name:
NAVARRO
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
BACHELORS DEGREE
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1073657276
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:
2307 W HORSESHOE PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TUCSON
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85745-1396
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-622-2597
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 S GREASEWOOD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUCSON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85745-2571
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-225-3300
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/19/2007

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: 235Z00000X , with the licence number:  SLP0717 , 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: 576605 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".