Provider Demographics
NPI:1598539504
Name:TODOR, SIMONA DEBORA
Entity Type:Individual
Prefix:
First Name:SIMONA
Middle Name:DEBORA
Last Name:TODOR
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 1:5964 W BLUEFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-0706
Mailing Address - Country:US
Mailing Address - Phone:480-678-7489
Mailing Address - Fax:
Practice Address - Street 1:5964 W BLUEFIELD AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-0706
Practice Address - Country:US
Practice Address - Phone:480-678-7489
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-09
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility