1437385416 NPI number — DIABETES AND HEART HEALTH CONSULTANTS LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437385416 NPI number — DIABETES AND HEART HEALTH CONSULTANTS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DIABETES AND HEART HEALTH CONSULTANTS 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:
DIABETES AND HEART HEALTH
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:
1437385416
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/04/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5420 W MURIEL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GLENDALE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85308-5380
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
623-521-5867
Provider Business Mailing Address Fax Number:
602-441-3934

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20100 N 51ST AVE
Provider Second Line Business Practice Location Address:
SUITE #F640
Provider Business Practice Location Address City Name:
GLENDALE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85308-5125
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-521-5867
Provider Business Practice Location Address Fax Number:
602-441-3934
Provider Enumeration Date:
06/04/2009

Additional Information

Authorized Official

Authorized Official Last Name:
SONI
Authorized Official First Name:
NIRALI
Authorized Official Middle Name:
Authorized Official Title or Position:
DIABETES PROGRAM MANAGER
Authorized Official Telephone Number:
623-521-5867

Provider Taxonomy Codes

  • Taxonomy code: 133NN1002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 171W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1835N1003X , with the licence number: S011205 , 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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