Provider Demographics
NPI:1871673657
Name:BIAGI, STACEY MARGO
Entity Type:Individual
Prefix:MS
First Name:STACEY
Middle Name:MARGO
Last Name:BIAGI
Suffix:
Gender:F
Credentials:
Other - Prefix:MR
Other - First Name:MICHAEL
Other - Middle Name:JAMES
Other - Last Name:RIVERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1170 W CHULA VISTA RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-3006
Mailing Address - Country:US
Mailing Address - Phone:520-743-8156
Mailing Address - Fax:
Practice Address - Street 1:1170 W CHULA VISTA RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-3006
Practice Address - Country:US
Practice Address - Phone:520-743-8156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4697385HR2055X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child