1740480359 NPI number — FOOTOMAKI TUCSON

Table of content: MISS ELNAZ JAMALI AFOUSI (NPI 1669621686)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740480359 NPI number — FOOTOMAKI TUCSON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FOOTOMAKI TUCSON
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:
6
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:
1740480359
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/12/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4444 E GRANT RD
Provider Second Line Business Mailing Address:
# 115
Provider Business Mailing Address City Name:
TUCSON
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85712
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-795-8650
Provider Business Mailing Address Fax Number:
520-795-8687

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4444 E GRANT RD
Provider Second Line Business Practice Location Address:
# 115
Provider Business Practice Location Address City Name:
TUCSON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85712
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-795-8650
Provider Business Practice Location Address Fax Number:
520-795-8687
Provider Enumeration Date:
07/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GIFFIN
Authorized Official First Name:
RITA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
520-795-8650

Provider Taxonomy Codes

  • Taxonomy code: 335E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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