Provider Demographics
NPI:1780012377
Name:LEGENZOSKI, RAYMOND (BS)
Entity Type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:
Last Name:LEGENZOSKI
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2529 E VISTA BONITA DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85024-7560
Mailing Address - Country:US
Mailing Address - Phone:480-342-8539
Mailing Address - Fax:
Practice Address - Street 1:4747 N 7TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-3653
Practice Address - Country:US
Practice Address - Phone:602-279-7655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-17
Last Update Date:2013-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management