1972814390 NPI number — KRISTINA JAY DPM

Table of content: KRISTINA JAY DPM (NPI 1972814390)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972814390 NPI number — KRISTINA JAY DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JAY
Provider First Name:
KRISTINA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPM
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JEZIDZIC
Provider Other First Name:
KRISTINA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DPM
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1972814390
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/12/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
33777 N SCOTTSDALE 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:
85266-1569
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-361-2500
Provider Business Mailing Address Fax Number:
602-513-7309

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
33777 N SCOTTSDALE RD STE 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SCOTTSDALE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85266-1569
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-361-2500
Provider Business Practice Location Address Fax Number:
602-513-7309
Provider Enumeration Date:
06/30/2010

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: 213ES0103X , with the licence number:  0759 , 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)