Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0100X | Occupational Health | 2020001-01-BE | AZ |
NPI | 1376132621 |
---|---|
Provider Name | Mrs. Alicia Paredes |
First Address | Glendale, AZ 85310-3292 |
Second Address | Phoenix, AZ 85012-1615 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/01/2021 |
Last Update Date | 12/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2020001-01-BE | STATE OF ARIZONA BOARD (01) | AZ |