1780695767 NPI number — MRS. ROXANNE MARIE PINCOMBE PT

Table of content: DR. DEV CRASTA PHD (NPI 1487302881)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780695767 NPI number — MRS. ROXANNE MARIE PINCOMBE PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PINCOMBE
Provider First Name:
ROXANNE
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PT
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:
1780695767
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/22/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 6570
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PEORIA
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85385-6570
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
623-398-8072
Provider Business Mailing Address Fax Number:
623-398-8235

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10355 N LA CANADA DR
Provider Second Line Business Practice Location Address:
SUITE 125
Provider Business Practice Location Address City Name:
ORO VALLEY
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85737-7305
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-822-8640
Provider Business Practice Location Address Fax Number:
520-822-8641
Provider Enumeration Date:
08/11/2006

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: 2251X0800X , with the licence number:  070-002081 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2251X0800X , with the licence number: 7473 , 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: 535050 . This is a "MEDICARE ID TYPE UNSPECIFIED" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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