Provider Demographics
NPI:1841282811
Name:LOSI, THERESE NICOLLE (DPM)
Entity type:Individual
Prefix:DR
First Name:THERESE
Middle Name:NICOLLE
Last Name:LOSI
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9515 W CAMELBACK RD STE 104
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85037-1365
Mailing Address - Country:US
Mailing Address - Phone:623-640-1799
Mailing Address - Fax:623-455-9388
Practice Address - Street 1:9515 W CAMELBACK RD STE 104
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-1365
Practice Address - Country:US
Practice Address - Phone:623-640-1799
Practice Address - Fax:623-455-9388
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-16
Last Update Date:2016-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ632213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
6181010001Medicare NSC