Healthcare Provider Details

I. General information

NPI: 1760658116
Provider Name (Legal Business Name): THERESA MARIE LOCOCO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: THERESA MARIE HUFFMAN MD

II. Dates (important events)

Enumeration Date: 05/06/2008
Last Update Date: 05/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 E THOMAS RD MEDICAL EDUCATION
PHOENIX AZ
85016-7710
US

IV. Provider business mailing address

1919 E THOMAS RD MEDICAL EDUCATION
PHOENIX AZ
85016-7710
US

V. Phone/Fax

Practice location:
  • Phone: 602-546-1000
  • Fax:
Mailing address:
  • Phone: 602-546-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number38136
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: