Provider Demographics
NPI:1912189689
Name:RADU, IOAN
Entity Type:Individual
Prefix:MR
First Name:IOAN
Middle Name:
Last Name:RADU
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 1:1022 E IRMA LN
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85024-4113
Mailing Address - Country:US
Mailing Address - Phone:623-587-1491
Mailing Address - Fax:623-587-1491
Practice Address - Street 1:1022 E IRMA LN
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85024-4113
Practice Address - Country:US
Practice Address - Phone:623-587-1491
Practice Address - Fax:623-587-1491
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-04
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZALH-5811310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ118399OtherALTECS PROVIDER ID