1639846272 NPI number — PATRICIA LEE CIARDULLI NP

Table of content: PATRICIA LEE CIARDULLI NP (NPI 1639846272)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639846272 NPI number — PATRICIA LEE CIARDULLI NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CIARDULLI
Provider First Name:
PATRICIA
Provider Middle Name:
LEE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LEE
Provider Other First Name:
TRISH
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
NP
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1639846272
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/15/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13535 N MARANA MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARANA
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85653-0990
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-887-1010
Provider Business Mailing Address Fax Number:
520-433-4900

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8165 N WADE RD
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:
85743-9582
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-887-1010
Provider Business Practice Location Address Fax Number:
520-527-1250
Provider Enumeration Date:
08/23/2021

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: 363LF0000X , with the licence number:  262021 , 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: 097662 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com