Provider Demographics
NPI:1093846172
Name:APODACA, IVETTE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:IVETTE
Middle Name:
Last Name:APODACA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34975 N NORTH VALLEY PKWY STE 138
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85086-4030
Mailing Address - Country:US
Mailing Address - Phone:602-404-0400
Mailing Address - Fax:602-404-0403
Practice Address - Street 1:34975 N NORTH VALLEY PKWY
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85086-4028
Practice Address - Country:US
Practice Address - Phone:602-404-0400
Practice Address - Fax:602-404-0403
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3276363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZMG1345265OtherDEA