Provider Demographics
NPI:1598937633
Name:BEDOYA, ADRIANA DEL CARMEN
Entity Type:Individual
Prefix:
First Name:ADRIANA
Middle Name:DEL CARMEN
Last Name:BEDOYA
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 1:10322 N 116TH LN
Mailing Address - Street 2:
Mailing Address - City:YOUNGTOWN
Mailing Address - State:AZ
Mailing Address - Zip Code:85363-1695
Mailing Address - Country:US
Mailing Address - Phone:623-842-1468
Mailing Address - Fax:
Practice Address - Street 1:10322 N 116TH LN
Practice Address - Street 2:
Practice Address - City:YOUNGTOWN
Practice Address - State:AZ
Practice Address - Zip Code:85363-1695
Practice Address - Country:US
Practice Address - Phone:623-842-1468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-28
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11262171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor