Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YS0200X | School Counselor | 3639584 | AZ |
NPI | 1184717449 |
---|---|
Provider Name | Mrs. Monica Arlett Buensuceso |
First Address | Buckeye, AZ 85326-4058 |
Second Address | Tolleson, AZ 85353-2941 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
124383 | AHCCCS PROVIDER ID (01) | AZ |