1336107218 NPI number — DR. SENECA AKASHA CARRILLO MD

Table of content: DR. SENECA AKASHA CARRILLO MD (NPI 1336107218)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336107218 NPI number — DR. SENECA AKASHA CARRILLO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARRILLO
Provider First Name:
SENECA
Provider Middle Name:
AKASHA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MESSMER
Provider Other First Name:
SENECA
Provider Other Middle Name:
AKASHA
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1336107218
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:
1740 E PURDUE AVE
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:
85020
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-405-0801
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5102 W CAMPBELL AVE
Provider Second Line Business Practice Location Address:
MARYVALE HOSPITAL
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85031
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-848-5000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/02/2006

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: 207P00000X , with the licence number:  31008 , 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: 3981220 . This is a "EVERCARE GRP" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 783721 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: AW1436 . This is a "HEALTHNET GRP" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: AZ0728670 . This is a "BLUE CROSS BLUE SHIELD GR" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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