Provider Demographics
NPI:1275969594
Name:BEGAY, VIRDELLE CECIL
Entity Type:Individual
Prefix:
First Name:VIRDELLE
Middle Name:CECIL
Last Name:BEGAY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 596
Mailing Address - Street 2:
Mailing Address - City:WINDOW ROCK
Mailing Address - State:AZ
Mailing Address - Zip Code:86515-0596
Mailing Address - Country:US
Mailing Address - Phone:928-729-5335
Mailing Address - Fax:928-729-5852
Practice Address - Street 1:5 MILES N RTE 12, MP 34
Practice Address - Street 2:
Practice Address - City:FORT DEFIANCE
Practice Address - State:AZ
Practice Address - Zip Code:86504
Practice Address - Country:US
Practice Address - Phone:928-729-5335
Practice Address - Fax:928-729-5852
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-18
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ463023450390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program