Healthcare Provider Details

I. General information

NPI: 1801344080
Provider Name (Legal Business Name): JESUS URBALEJO-SALCIDO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2016
Last Update Date: 09/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 N COUNTRY CLUB DR
MESA AZ
85201-3307
US

IV. Provider business mailing address

9800 E QUARTERLINE RD
MESA AZ
85207-6228
US

V. Phone/Fax

Practice location:
  • Phone: 480-472-0502
  • Fax:
Mailing address:
  • Phone: 480-472-9086
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN180949
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: