Provider Demographics
NPI:1750679239
Name:MOISIU, GEORGETA
Entity Type:Individual
Prefix:MRS
First Name:GEORGETA
Middle Name:
Last Name:MOISIU
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 1:13535 W CANYON CREEK DR
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-5407
Mailing Address - Country:US
Mailing Address - Phone:623-594-2294
Mailing Address - Fax:623-328-7031
Practice Address - Street 1:13535 W CANYON CREEK DR
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-5407
Practice Address - Country:US
Practice Address - Phone:623-594-2294
Practice Address - Fax:623-328-7031
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-18
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAL6904H311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ572046OtherAHCCCS