Provider Demographics
NPI:1013721539
Name:CURTIS, CONDA CHE
Entity type:Individual
Prefix:MRS
First Name:CONDA
Middle Name:CHE
Last Name:CURTIS
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 1:19523 N TOYA ST
Mailing Address - Street 2:
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85138-2930
Mailing Address - Country:US
Mailing Address - Phone:313-703-9675
Mailing Address - Fax:
Practice Address - Street 1:19523 N TOYA ST
Practice Address - Street 2:
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85138-2930
Practice Address - Country:US
Practice Address - Phone:313-703-9675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-04
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
AZD07875917172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
No171M00000XOther Service ProvidersCase Manager/Care Coordinator