Provider Demographics
NPI:1922271485
Name:HADJIPENTCHEV, COCA AIDA
Entity Type:Individual
Prefix:MRS
First Name:COCA
Middle Name:AIDA
Last Name:HADJIPENTCHEV
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 1:1020 W PONTIAC DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-5713
Mailing Address - Country:US
Mailing Address - Phone:623-748-8108
Mailing Address - Fax:623-466-7753
Practice Address - Street 1:1020 W PONTIAC DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-5713
Practice Address - Country:US
Practice Address - Phone:623-748-8108
Practice Address - Fax:623-466-7753
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-04
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZALH-5691310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ082984OtherAHCCCS PROVIDER ID