1205508405 NPI number — BVO PROFESSIONAL SERVICES, LLC

Table of content: MS. PAMELA BETH WOOD MA, LAT, ATR (NPI 1427797182)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205508405 NPI number — BVO PROFESSIONAL SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BVO PROFESSIONAL SERVICES, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1205508405
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/05/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
875 S ESTRELLA PARKWAY
Provider Second Line Business Mailing Address:
#7592
Provider Business Mailing Address City Name:
GOODYEAR
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85338
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17769 W CASSIA WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GOODYEAR
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85338-6430
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-462-1047
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/05/2021

Additional Information

Authorized Official

Authorized Official Last Name:
ONUSELOGU
Authorized Official First Name:
BRYAN
Authorized Official Middle Name:
Authorized Official Title or Position:
AUTHORIZED OFFICIAL
Authorized Official Telephone Number:
480-462-1047

Provider Taxonomy Codes

  • Taxonomy code: 253Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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