Healthcare Provider Details

I. General information

NPI: 1538709134
Provider Name (Legal Business Name): MS. TERESA SOCIO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TERESA SOCIO GARCIA

II. Dates (important events)

Enumeration Date: 01/10/2020
Last Update Date: 01/10/2020
Certification Date: 01/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5555 W THUNDERBIRD RD
GLENDALE AZ
85306-4622
US

IV. Provider business mailing address

2954 E LARKSPUR DR
PHOENIX AZ
85032-7152
US

V. Phone/Fax

Practice location:
  • Phone: 602-865-5555
  • Fax:
Mailing address:
  • Phone: 480-330-5996
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number236354
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License Number236354
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: