Provider Demographics
NPI:1801069265
Name:NOGALES INFANTIL
Entity type:Organization
Organization Name:NOGALES INFANTIL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROJECT DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:GUILLEN
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MME
Authorized Official - Phone:520-988-2241
Mailing Address - Street 1:20 NAVAJO WAY
Mailing Address - Street 2:
Mailing Address - City:NOGALES
Mailing Address - State:AZ
Mailing Address - Zip Code:85621-3914
Mailing Address - Country:US
Mailing Address - Phone:520-988-2241
Mailing Address - Fax:
Practice Address - Street 1:20 NAVAJO WAY
Practice Address - Street 2:
Practice Address - City:NOGALES
Practice Address - State:AZ
Practice Address - Zip Code:85621-3914
Practice Address - Country:US
Practice Address - Phone:520-088-2241
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-08
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251V00000XAgenciesVoluntary or Charitable
No175F00000XOther Service ProvidersNaturopathGroup - Single Specialty