Healthcare Provider Details

I. General information

NPI: 1497473177
Provider Name (Legal Business Name): ALEXANDER A DARMAWASKITA SLPA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2022
Last Update Date: 08/18/2022
Certification Date: 08/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3701 E BROADWAY AVE
APACHE JUNCTION AZ
85119-9301
US

IV. Provider business mailing address

2066 E LIBRA PL
CHANDLER AZ
85249-5204
US

V. Phone/Fax

Practice location:
  • Phone: 480-677-7510
  • Fax:
Mailing address:
  • Phone: 480-616-6153
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSLPA14028
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: