1508911710 NPI number — MR. RICHARD A AYIYI SR. CEO

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508911710 NPI number — MR. RICHARD A AYIYI SR. CEO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AYIYI
Provider First Name:
RICHARD
Provider Middle Name:
A
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
SR.
Provider Credential Text:
CEO
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WINDHAM
Provider Other First Name:
JACK
Provider Other Middle Name:
G
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
GENERAL MANAGER
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1508911710
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5270 N 59TH AVE
Provider Second Line Business Mailing Address:
SUITE 18
Provider Business Mailing Address City Name:
GLENDALE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85301-6762
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
623-934-5291
Provider Business Mailing Address Fax Number:
623-847-9898

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5270 N 59TH AVE
Provider Second Line Business Practice Location Address:
SUITE 18
Provider Business Practice Location Address City Name:
GLENDALE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85301-6762
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-934-5291
Provider Business Practice Location Address Fax Number:
623-847-9898
Provider Enumeration Date:
01/25/2007

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: 1223G0001X , with the licence number:  D6399 , 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)