1275651507 NPI number — ALEX J ONOFREI MD PC

Table of content: (NPI 1275651507)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275651507 NPI number — ALEX J ONOFREI MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALEX J ONOFREI MD PC
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:
AZ FAMILY MEDICINE & SPORTS MEDICINE
Provider Other Organization Name Type Code:
3
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:
1275651507
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/24/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6130 E BROWN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MESA
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85205-4960
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-807-3554
Provider Business Mailing Address Fax Number:
480-807-8330

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6130 E BROWN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MESA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85205-4960
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-807-3554
Provider Business Practice Location Address Fax Number:
480-807-8330
Provider Enumeration Date:
03/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
COUNTS
Authorized Official First Name:
LEIJA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
480-807-3554

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  24575 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207Q00000X , with the licence number: 26832 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207QS0010X , with the licence number: 24575 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: Z106145 . This is a "MEDICARE ID-PIN" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com