1245340165 NPI number — MS. PAULETTE LEGUIZAMON CFNP

Table of content: MS. PAULETTE LEGUIZAMON CFNP (NPI 1245340165)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245340165 NPI number — MS. PAULETTE LEGUIZAMON CFNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEGUIZAMON
Provider First Name:
PAULETTE
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
CFNP
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:
1245340165
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/12/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
19560 N CANYON WHISPER DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SURPRISE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85387-4403
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
623-815-2900
Provider Business Mailing Address Fax Number:
623-583-1319

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14973 W BELL RD
Provider Second Line Business Practice Location Address:
SUITE #100
Provider Business Practice Location Address City Name:
SURPRISE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85374-3202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-815-2900
Provider Business Practice Location Address Fax Number:
623-583-1319
Provider Enumeration Date:
08/30/2006

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: 163WG0000X , with the licence number:  AP1677AZ , 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: 870362 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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