Provider Demographics
NPI:1699858456
Name:ALDAMA, THERESA IRENE (RNFA)
Entity Type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:IRENE
Last Name:ALDAMA
Suffix:
Gender:F
Credentials:RNFA
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 6565
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85312-6565
Mailing Address - Country:US
Mailing Address - Phone:623-412-3425
Mailing Address - Fax:623-776-9954
Practice Address - Street 1:5127 W CHOLLA ST
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85304-3410
Practice Address - Country:US
Practice Address - Phone:623-412-3425
Practice Address - Fax:623-776-9954
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN029258163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ163WR0006XOtherREGISTERED NURSE FIRST AS