Provider Demographics
NPI:1881330439
Name:LEGUIZAMO, EDITH LUZ (PMHNP)
Entity type:Individual
Prefix:
First Name:EDITH
Middle Name:LUZ
Last Name:LEGUIZAMO
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:EDITH
Other - Middle Name:LUZ
Other - Last Name:HERNANDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6677 W THUNDERBIRD RD STE I164
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-3762
Mailing Address - Country:US
Mailing Address - Phone:623-878-2100
Mailing Address - Fax:623-776-9419
Practice Address - Street 1:6677 W THUNDERBIRD RD STE I164
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-3762
Practice Address - Country:US
Practice Address - Phone:623-878-2100
Practice Address - Fax:623-776-9419
Is Sole Proprietor?:No
Enumeration Date:2022-05-06
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ273165363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health