Provider Demographics
NPI:1942262787
Name:VALDEZ DE VERDUZCO, ROSA GUADALUPE (CSA)
Entity Type:Individual
Prefix:MRS
First Name:ROSA
Middle Name:GUADALUPE
Last Name:VALDEZ DE VERDUZCO
Suffix:
Gender:F
Credentials:CSA
Other - Prefix:
Other - First Name:ROSA
Other - Middle Name:GUADALUPE
Other - Last Name:VERDUZCO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CSA
Mailing Address - Street 1:PO BOX 3262
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85244
Mailing Address - Country:US
Mailing Address - Phone:480-634-5521
Mailing Address - Fax:480-248-9011
Practice Address - Street 1:2927 NORTH 34TH PLACE
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85213
Practice Address - Country:US
Practice Address - Phone:480-634-5521
Practice Address - Fax:480-248-9011
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2015-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0148226OtherBCBS