Provider Demographics
NPI:1083215735
Name:LABRADA IZQUIERDO, AHECIO ALEXANDER (APRN)
Entity Type:Individual
Prefix:
First Name:AHECIO
Middle Name:ALEXANDER
Last Name:LABRADA IZQUIERDO
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6114 N 59TH AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85301-7769
Mailing Address - Country:US
Mailing Address - Phone:623-937-8643
Mailing Address - Fax:623-934-1249
Practice Address - Street 1:6114 N 59TH AVE STE 4
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85301-7769
Practice Address - Country:US
Practice Address - Phone:623-937-8643
Practice Address - Fax:623-934-1249
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-07
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11010075363LF0000X
AZ251902363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily