Provider Demographics
NPI:1235391145
Name:TAGLE-GALASSO, MARIA THERESA (NP)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:THERESA
Last Name:TAGLE-GALASSO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:14001 N 7TH ST
Mailing Address - Street 2:SUITE G114
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85022-4382
Mailing Address - Country:US
Mailing Address - Phone:602-298-6930
Mailing Address - Fax:602-298-6918
Practice Address - Street 1:14001 N 7TH ST
Practice Address - Street 2:SUITE G114
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85022-4382
Practice Address - Country:US
Practice Address - Phone:602-298-6930
Practice Address - Fax:602-298-6918
Is Sole Proprietor?:No
Enumeration Date:2008-07-01
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN102382363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics