Provider Demographics
NPI:1093373284
Name:TREVIZO, ODILETTE (RN, BSN)
Entity Type:Individual
Prefix:
First Name:ODILETTE
Middle Name:
Last Name:TREVIZO
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7115 W DARROW ST
Mailing Address - Street 2:
Mailing Address - City:LAVEEN
Mailing Address - State:AZ
Mailing Address - Zip Code:85339-2636
Mailing Address - Country:US
Mailing Address - Phone:602-510-3948
Mailing Address - Fax:
Practice Address - Street 1:BEAUTIFUL YOU MED SPA
Practice Address - Street 2:123 E BASELINE RD STE D208
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283
Practice Address - Country:US
Practice Address - Phone:602-510-3948
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-03
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN159708163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZRN159708OtherRN