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NPI Code Detail

MEDICARE: MONICA R VANDIVORT M.D.

MEDICARE: MONICA R VANDIVORT M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207RG0300XGeriatric Medicine (Internal Medicine) Physician26972AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1720044365
Entity Type Code : Individual
Provider Name (Legal Business Name) : MONICA R VANDIVORT M.D.
Provider Business Mailing Address
First Line : 599 E WILCOX DR
Second Line :
City : SIERRA VISTA
State : AZ
Zip : 85635-2531
Country : US
Telephone Number : 520-459-4604
Fax Number : 520-459-4603
Provider Business Practice Location Address
First Line : 599 E WILCOX DR
Second Line :
City : SIERRA VISTA
State : AZ
Zip : 85635-2531
Country : US
Telephone Number : 520-459-4604
Fax Number : 520-458-2444
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/22/2006
Last Update Date : 04/15/2024

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