Healthcare Provider Details

I. General information

NPI: 1487668331
Provider Name (Legal Business Name): DANIELA DIPOMAZIO CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 09/08/2021
Certification Date: 09/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 E ROOSEVELT ST
PHOENIX AZ
85008-4948
US

IV. Provider business mailing address

5714 W IVANHOE ST
CHANDLER AZ
85226-1822
US

V. Phone/Fax

Practice location:
  • Phone: 602-344-5143
  • Fax:
Mailing address:
  • Phone: 602-828-8188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberCRNA0161
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number026-0032061
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: