Healthcare Provider Details

I. General information

NPI: 1407195696
Provider Name (Legal Business Name): ANGELICA BADILLO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANGIE VALDEZ

II. Dates (important events)

Enumeration Date: 02/07/2013
Last Update Date: 02/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1374 W FRONTAGE RD
RIO RICO AZ
85648-6377
US

IV. Provider business mailing address

208 PASEO TAMEX
RIO RICO AZ
85648-1041
US

V. Phone/Fax

Practice location:
  • Phone: 520-375-8600
  • Fax: 520-375-8690
Mailing address:
  • Phone: 520-860-0262
  • Fax: 520-375-8690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN170757
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: