Provider Demographics
NPI:1700146289
Name:GILES, TORIYANA MAKEBA (LPN)
Entity Type:Individual
Prefix:MS
First Name:TORIYANA
Middle Name:MAKEBA
Last Name:GILES
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:TORIYANA
Other - Middle Name:MAKEBA
Other - Last Name:PAYNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 31001-0698
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91110-0698
Mailing Address - Country:US
Mailing Address - Phone:602-263-1200
Mailing Address - Fax:602-200-5383
Practice Address - Street 1:4212 N 16TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-5319
Practice Address - Country:US
Practice Address - Phone:602-263-1200
Practice Address - Fax:602-200-5382
Is Sole Proprietor?:No
Enumeration Date:2012-05-18
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL2159216164W00000X
AZLP050633164W00000X
FLPN5191000164W00000X
MI4703108503164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse