1336372184 NPI number — MRS. KATHRYN RUTH KOCOS R.D.H.

Table of content: MRS. KATHRYN RUTH KOCOS R.D.H. (NPI 1336372184)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336372184 NPI number — MRS. KATHRYN RUTH KOCOS R.D.H.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOCOS
Provider First Name:
KATHRYN
Provider Middle Name:
RUTH
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
R.D.H.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LUTZE
Provider Other First Name:
KATHRYN
Provider Other Middle Name:
RUTH
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1336372184
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/27/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13706 W BELL RD
Provider Second Line Business Mailing Address:
STE 2
Provider Business Mailing Address City Name:
SURPRISE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85314
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
623-584-9910
Provider Business Mailing Address Fax Number:
623-584-9940

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2025 N PEBBLECREEK PKWY
Provider Second Line Business Practice Location Address:
SUITE A-11
Provider Business Practice Location Address City Name:
GOODYEAR
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85395
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-214-9979
Provider Business Practice Location Address Fax Number:
623-935-0774
Provider Enumeration Date:
08/27/2009

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: 124Q00000X , with the licence number:  H5360 , 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)





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