Provider Demographics
NPI:1821843004
Name:KOMERDELJ, ALEXANDER
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:
Last Name:KOMERDELJ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15743 E JERICHO DR
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN HILLS
Mailing Address - State:AZ
Mailing Address - Zip Code:85268-3912
Mailing Address - Country:US
Mailing Address - Phone:480-415-5721
Mailing Address - Fax:
Practice Address - Street 1:15663 E RICHWOOD AVE
Practice Address - Street 2:
Practice Address - City:FOUNTAIN HILLS
Practice Address - State:AZ
Practice Address - Zip Code:85268-1531
Practice Address - Country:US
Practice Address - Phone:480-415-5721
Practice Address - Fax:480-837-4803
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-20
Last Update Date:2024-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility