Provider Demographics
NPI:1558945782
Name:BULUBENCHI, DANIELA V
Entity Type:Individual
Prefix:
First Name:DANIELA
Middle Name:V
Last Name:BULUBENCHI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1808 E CIRCLE MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:NEW RIVER
Mailing Address - State:AZ
Mailing Address - Zip Code:85087-7592
Mailing Address - Country:US
Mailing Address - Phone:623-734-5905
Mailing Address - Fax:623-691-8106
Practice Address - Street 1:37509 N 16TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85086-9363
Practice Address - Country:US
Practice Address - Phone:623-734-5905
Practice Address - Fax:623-691-8106
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-12
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAL8827H314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ46-1346754OtherASSISTED LIVING FACILITY
AZ46-1346754Medicaid
AZ461346754OtherSKILLED NURSING FACILITY