Healthcare Provider Details

I. General information

NPI: 1992016034
Provider Name (Legal Business Name): MRS. JILL MARIE HAUGO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JILL MARIE BAUGNIET

II. Dates (important events)

Enumeration Date: 06/23/2010
Last Update Date: 06/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15333 N PIMA RD STE 103
SCOTTSDALE AZ
85260
US

IV. Provider business mailing address

15333 N PIMA RD STE 103
SCOTTSDALE AZ
85260
US

V. Phone/Fax

Practice location:
  • Phone: 602-298-1388
  • Fax: 602-298-1391
Mailing address:
  • Phone: 602-298-1388
  • Fax: 602-298-1391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code126900000X
TaxonomyDental Laboratory Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: