1205365772 NPI number — MRS. IRINA VLADIMIROVNA ASHAMALLA MSN, FNP-C, PMHNP-BC

Table of content: MRS. IRINA VLADIMIROVNA ASHAMALLA MSN, FNP-C, PMHNP-BC (NPI 1205365772)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205365772 NPI number — MRS. IRINA VLADIMIROVNA ASHAMALLA MSN, FNP-C, PMHNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ASHAMALLA
Provider First Name:
IRINA
Provider Middle Name:
VLADIMIROVNA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSN, FNP-C, PMHNP-BC
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:
1205365772
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/23/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14811 W BELL RD STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SURPRISE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85374-7602
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
623-328-7323
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10210 W HAPPY VALLEY PKWY STE 145
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PEORIA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85383-2881
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-906-8301
Provider Business Practice Location Address Fax Number:
623-404-6602
Provider Enumeration Date:
06/08/2017

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: 363LF0000X , with the licence number:  AP10066 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X , with the licence number: AP10066 , 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)