1588340657 NPI number — MRS. AMANDA FORD CENICEROS FNP

Table of content: MRS. AMANDA FORD CENICEROS FNP (NPI 1588340657)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588340657 NPI number — MRS. AMANDA FORD CENICEROS FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CENICEROS
Provider First Name:
AMANDA
Provider Middle Name:
FORD
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
FNP
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:
1588340657
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/08/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5055 E BROADWAY BLVD STE A100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TUCSON
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85711-3629
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-795-4783
Provider Business Mailing Address Fax Number:
520-547-5797

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6236 E PIMA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUCSON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85712-3154
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-327-6874
Provider Business Practice Location Address Fax Number:
520-327-0028
Provider Enumeration Date:
06/23/2023

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: 207Q00000X , with the licence number:  293846 , 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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