1225255284 NPI number — MRS. MARIANN ARCARI RUBIN

Table of content: MRS. MARIANN ARCARI RUBIN (NPI 1225255284)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225255284 NPI number — MRS. MARIANN ARCARI RUBIN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RUBIN
Provider First Name:
MARIANN
Provider Middle Name:
ARCARI
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:
ARCARI
Provider Other First Name:
MARIANN
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1225255284
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11309 E PETRA AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MESA
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85212-1981
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-380-6248
Provider Business Mailing Address Fax Number:
480-986-2618

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7254 E SOUTHERN AVE
Provider Second Line Business Practice Location Address:
SUITE 123
Provider Business Practice Location Address City Name:
MESA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85209-2786
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-380-6248
Provider Business Practice Location Address Fax Number:
480-986-2618
Provider Enumeration Date:
04/19/2007

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: 1041C0700X , with the licence number:  AZ11566 , 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: 107699734 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 12042 . This is a "VALUE OPTIONS" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 204432 . This is a "MHN" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 2016596 . This is a "CIGNA" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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