Healthcare Provider Details

I. General information

NPI: 1700335528
Provider Name (Legal Business Name): BELMA FIFIC CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2016
Last Update Date: 11/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 N CENTRAL AVE SUITE 1600
PHOENIX AZ
85004-4527
US

IV. Provider business mailing address

1850 N CENTRAL AVE SUITE 1600
PHOENIX AZ
85004-4527
US

V. Phone/Fax

Practice location:
  • Phone: 602-262-8900
  • Fax:
Mailing address:
  • Phone: 602-262-8900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberCRNA1349
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN137636
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: