Healthcare Provider Details

I. General information

NPI: 1821688045
Provider Name (Legal Business Name): SERENA J EFFING
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/21/2021
Last Update Date: 01/21/2021
Certification Date: 01/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 E 5TH ST APT 1102
TUCSON AZ
85711-2238
US

IV. Provider business mailing address

4900 E 5TH ST APT 1102
TUCSON AZ
85711-2238
US

V. Phone/Fax

Practice location:
  • Phone: 520-912-2823
  • Fax:
Mailing address:
  • Phone: 520-912-2823
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateAZ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1831683358
Identifier TypeOTHER
Identifier StateAZ
Identifier IssuerADORA ALLIANCE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: