Healthcare Provider Details

I. General information

NPI: 1881371557
Provider Name (Legal Business Name): IRMA LETICIA SANTAMARIA FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: IRMA LETICIA CAMACHO

II. Dates (important events)

Enumeration Date: 07/03/2023
Last Update Date: 07/30/2024
Certification Date: 07/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5601 W EUGIE AVE STE 203
GLENDALE AZ
85304-1258
US

IV. Provider business mailing address

3815 E BELL RD STE 4500
PHOENIX AZ
85032-2171
US

V. Phone/Fax

Practice location:
  • Phone: 602-633-3833
  • Fax: 602-633-3834
Mailing address:
  • Phone: 602-633-3848
  • Fax: 602-633-3841

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number293865
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN155417
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: