1720065113 NPI number — SERRINA MARIE YOZSA DPM

Table of content: SERRINA MARIE YOZSA DPM (NPI 1720065113)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720065113 NPI number — SERRINA MARIE YOZSA DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YOZSA
Provider First Name:
SERRINA
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPM
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
YOZSA-JEMMETT
Provider Other First Name:
SERRINA
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DPM
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1720065113
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/06/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3501 N SCOTTSDALE RD STE 246
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SCOTTSDALE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85251-5630
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-994-3668
Provider Business Mailing Address Fax Number:
480-663-8110

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3501 N SCOTTSDALE RD STE 246
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SCOTTSDALE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85251-5630
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-994-3668
Provider Business Practice Location Address Fax Number:
480-663-8110
Provider Enumeration Date:
12/27/2005

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: 213E00000X , with the licence number:  0514 , 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: 477233 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 78698 . This is a "MEDICARE GROUP PIN" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 2Z0160 . This is a "HEALTHNET PIN" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 7167058 . This is a "AETNA PIN" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 602490600 . This is a "DEPT OF LABOR" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: AZ0195150 . This is a "BCBSAZ PIN" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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