1720451834 NPI number — CENTRAL ARIZONA LACTATION

Table of content: (NPI 1720451834)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720451834 NPI number — CENTRAL ARIZONA LACTATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRAL ARIZONA LACTATION
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:
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:
1720451834
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/22/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7730 E GREENWAY RD STE 101
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SCOTTSDALE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85260-1787
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-208-1490
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15720 N GREENWAY HAYDEN LOOP
Provider Second Line Business Practice Location Address:
SUITE 8A
Provider Business Practice Location Address City Name:
SCOTTSDALE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85260-1230
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-800-7707
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/11/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
RIEK
Authorized Official First Name:
CARA
Authorized Official Middle Name:
Authorized Official Title or Position:
CO-OWNER
Authorized Official Telephone Number:
480-208-1490

Provider Taxonomy Codes

  • Taxonomy code: 163WL0100X , with the licence number:  RN168695 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 364SF0001X , with the licence number: AP8745 , 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)