Provider Demographics
NPI:1043210198
Name:JACINTO, LETICIA G (MD)
Entity Type:Individual
Prefix:DR
First Name:LETICIA
Middle Name:G
Last Name:JACINTO
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:17100 N 67TH AVE
Mailing Address - Street 2:STE 401
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-3698
Mailing Address - Country:US
Mailing Address - Phone:602-795-8698
Mailing Address - Fax:602-795-8699
Practice Address - Street 1:17100 N 67TH AVE
Practice Address - Street 2:STE 401
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-3698
Practice Address - Country:US
Practice Address - Phone:602-795-8698
Practice Address - Fax:602-795-8699
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-29
Last Update Date:2017-11-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ290062084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZH05225Medicare UPIN