1922271485 NPI number — MRS. COCA AIDA HADJIPENTCHEV

Table of content: MRS. COCA AIDA HADJIPENTCHEV (NPI 1922271485)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922271485 NPI number — MRS. COCA AIDA HADJIPENTCHEV

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HADJIPENTCHEV
Provider First Name:
COCA
Provider Middle Name:
AIDA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
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:
1922271485
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/04/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1020 W PONTIAC DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85027-5713
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
623-748-8108
Provider Business Mailing Address Fax Number:
623-466-7753

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1020 W PONTIAC DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85027-5713
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-748-8108
Provider Business Practice Location Address Fax Number:
623-466-7753
Provider Enumeration Date:
04/04/2008

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: 310400000X , with the licence number:  ALH-5691 , 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: 082984 . This is a "AHCCCS PROVIDER ID" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".