1346282076 NPI number — HONORHEALTH MEDICAL GROUP, LLC

Table of content: MARIA THERESA LOUISE BAUTISTA OTR, OTD (NPI 1962192807)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346282076 NPI number — HONORHEALTH MEDICAL GROUP, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HONORHEALTH MEDICAL GROUP, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1346282076
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/17/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2500 W UTOPIA RD STE 100
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:
85027-4172
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-587-5314
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4712 E DYNAMITE BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAVE CREEK
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85331-6243
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-342-8711
Provider Business Practice Location Address Fax Number:
480-342-7077
Provider Enumeration Date:
06/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PETRIDES
Authorized Official First Name:
SAVAS
Authorized Official Middle Name:
Authorized Official Title or Position:
SVP/CEO
Authorized Official Telephone Number:
480-696-4020

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  GROUP NPI , 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)





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