Provider Demographics
NPI:1427409705
Name:MEDIPRO HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:MEDIPRO HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERESITA
Authorized Official - Middle Name:M
Authorized Official - Last Name:TADAYA
Authorized Official - Suffix:
Authorized Official - Credentials:BS, CMA(AAMA), ALFM
Authorized Official - Phone:623-330-0357
Mailing Address - Street 1:2659 W GUADALUPE RD
Mailing Address - Street 2:BLDG. C-116 AND 119
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-7254
Mailing Address - Country:US
Mailing Address - Phone:623-330-0357
Mailing Address - Fax:623-374-2673
Practice Address - Street 1:2659 W GUADALUPE RD
Practice Address - Street 2:BLDG. C-116 AND 119
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-7254
Practice Address - Country:US
Practice Address - Phone:623-330-0357
Practice Address - Fax:623-374-2673
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-28
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health