=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083499081
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BAHAR CAMORIANO RN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/28/2023
-----------------------------------------------------
Last Update Date | 08/28/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13630 N 12TH PL
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85022-4968
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 520-333-8390
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1305 N MARTIN AVE TUCSON AZ 85721
-----------------------------------------------------
City | TUCSON
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85721-0001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 520-626-6154
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | 23881286
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------