1780669747 NPI number — KAREN E APODACA MD

Table of content: KAREN E APODACA MD (NPI 1780669747)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780669747 NPI number — KAREN E APODACA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
APODACA
Provider First Name:
KAREN
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1780669747
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/17/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
401 S CALVARY WAY
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
COTTONWOOD
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
86326-4165
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-634-6369
Provider Business Mailing Address Fax Number:
928-634-6389

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
401 S CALVARY WAY
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
COTTONWOOD
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86326-4165
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-634-6369
Provider Business Practice Location Address Fax Number:
928-634-6389
Provider Enumeration Date:
12/13/2005

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: 207Q00000X , with the licence number:  19568 , 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: Z168884 . This is a "HUMANITY HEALTH PROVIDERS GROUP PTAN" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: Z182914 . This is a "INDIVIDUAL PTAN" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 298895 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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