1932268752 NPI number — DR. RACHEL K SY DO

Table of content: DR. RACHEL K SY DO (NPI 1932268752)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932268752 NPI number — DR. RACHEL K SY DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SY
Provider First Name:
RACHEL
Provider Middle Name:
K
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KASUKONIS
Provider Other First Name:
RACHEL
Provider Other Middle Name:
K
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1932268752
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/22/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2702 NORTH 3RD STREET
Provider Second Line Business Mailing Address:
STE. 4020
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85004-4608
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-323-3344
Provider Business Mailing Address Fax Number:
602-323-3496

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1492 SOUTH MILL AVENUE
Provider Second Line Business Practice Location Address:
SUITE 312
Provider Business Practice Location Address City Name:
TEMPE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85281-5676
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-243-7277
Provider Business Practice Location Address Fax Number:
480-927-1092
Provider Enumeration Date:
12/07/2006

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: 207Q00000X , with the licence number:  4340 , 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: 212519 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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