Provider Demographics
NPI:1013487180
Name:MALUTAN, LUDOVICA RODICA
Entity Type:Individual
Prefix:
First Name:LUDOVICA
Middle Name:RODICA
Last Name:MALUTAN
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 1:5019 W PARADISE LN
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-2655
Mailing Address - Country:US
Mailing Address - Phone:602-639-2351
Mailing Address - Fax:
Practice Address - Street 1:5019 W PARADISE LN
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-2655
Practice Address - Country:US
Practice Address - Phone:602-639-2351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-30
Last Update Date:2018-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAL10844H310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ437243Medicaid