1942418132 NPI number — MAFFI PLASTIC SURGERY PC

Table of content: (NPI 1942418132)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942418132 NPI number — MAFFI PLASTIC SURGERY PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MAFFI PLASTIC SURGERY PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1942418132
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/13/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5410 N SCOTTSDALE RD
Provider Second Line Business Mailing Address:
SUITE E-200
Provider Business Mailing Address City Name:
PARADISE VALLEY
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85253-5927
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-505-6430
Provider Business Mailing Address Fax Number:
480-505-6429

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5410 N SCOTTSDALE RD
Provider Second Line Business Practice Location Address:
SUITE E-200
Provider Business Practice Location Address City Name:
PARADISE VALLEY
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85253-5927
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-505-6430
Provider Business Practice Location Address Fax Number:
480-505-6429
Provider Enumeration Date:
05/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MAFFI
Authorized Official First Name:
TERRY
Authorized Official Middle Name:
R
Authorized Official Title or Position:
OWNER PHYSICIAN
Authorized Official Telephone Number:
480-505-6430

Provider Taxonomy Codes

  • Taxonomy code: 208200000X , with the licence number:  32805 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2082S0099X , with the licence number: 32805 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: AZ0768540 . This is a "BC OF AZ PROVIDER NUMBER" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 868292 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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