Provider Demographics
NPI:1356593289
Name:POP, CORINA MAGDALENA (ADMINISTRATOR)
Entity type:Individual
Prefix:
First Name:CORINA
Middle Name:MAGDALENA
Last Name:POP
Suffix:
Gender:F
Credentials:ADMINISTRATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6929 W LONE CACTUS DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-8951
Mailing Address - Country:US
Mailing Address - Phone:623-249-3592
Mailing Address - Fax:623-249-3591
Practice Address - Street 1:6929 W LONE CACTUS DR
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-8951
Practice Address - Country:US
Practice Address - Phone:623-249-3592
Practice Address - Fax:623-249-3591
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-22
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZALH-P-6432251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health