1356324834 NPI number — MAURISA O KONYA P.A.

Table of content: MAURISA O KONYA P.A. (NPI 1356324834)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356324834 NPI number — MAURISA O KONYA P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KONYA
Provider First Name:
MAURISA
Provider Middle Name:
O
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
P.A.
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:
1356324834
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/12/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4550 E. BELL ROAD
Provider Second Line Business Mailing Address:
SUITE 170
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85032
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-443-8400
Provider Business Mailing Address Fax Number:
480-443-8697

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5601 W. EUGIE AVE.
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
GLENDALE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85304
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-443-8400
Provider Business Practice Location Address Fax Number:
480-443-8697
Provider Enumeration Date:
11/29/2005

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: 363A00000X , with the licence number:  2531 , 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: 2531 . This is a "ARIZONA PA LICENSE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com