1508406745 NPI number — TAILORED 2 U PSYCHIATRY, PLLC

Table of content: (NPI 1508406745)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508406745 NPI number — TAILORED 2 U PSYCHIATRY, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TAILORED 2 U PSYCHIATRY, PLLC
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:
MARGARITA MADRID DBA TAILORED 2 U PSCYHIATRY, PLLC
Provider Other Organization Name Type Code:
3
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:
1508406745
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/21/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17505 N 79TH AVE
Provider Second Line Business Mailing Address:
STE 213A
Provider Business Mailing Address City Name:
GLENDALE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85308-8728
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-584-5859
Provider Business Mailing Address Fax Number:
602-584-5860

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17505 N 79TH AVE
Provider Second Line Business Practice Location Address:
STE 213A
Provider Business Practice Location Address City Name:
GLENDALE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85308-8728
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-584-5859
Provider Business Practice Location Address Fax Number:
602-584-5860
Provider Enumeration Date:
01/15/2020

Additional Information

Authorized Official

Authorized Official Last Name:
MADRID
Authorized Official First Name:
MARGARITA
Authorized Official Middle Name:
Authorized Official Title or Position:
PROVIDER/OWNER
Authorized Official Telephone Number:
602-584-5859

Provider Taxonomy Codes

  • Taxonomy code: 363LP0808X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1619476207 . This is a "NPI" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 1508406745 . This is a "GROUP NPI" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 357792 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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