Provider Demographics
NPI:1710097225
Name:TAN-FERMO, LETTY GUPIT (MD)
Entity Type:Individual
Prefix:DR
First Name:LETTY
Middle Name:GUPIT
Last Name:TAN-FERMO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4747 N 7TH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-3653
Mailing Address - Country:US
Mailing Address - Phone:602-279-7655
Mailing Address - Fax:602-264-1806
Practice Address - Street 1:5701 W TALAVI BLVD
Practice Address - Street 2:SUITE 180
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-1886
Practice Address - Country:US
Practice Address - Phone:623-486-8082
Practice Address - Fax:623-486-2739
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ283202084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZH18971Medicare UPIN
AZ69380Medicare ID - Type Unspecified