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General NPI Number Information
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NPI Number | 1316847122
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Entity Type | Organization
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Legal Business Name | ALTA VIDA PSYCHIATRY, PLLC
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Dates
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Enumeration Date | 11/06/2026
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Last Update Date | 11/06/2026
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Provider Practice Location Address
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Address Line | 2525 S RURAL RD STE 4N
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City | TEMPE
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State | AZ
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Zip | 85282-2442
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Country | US
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Telephone | 480-499-0102
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Fax | 480-499-0295
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Provider Business Mailing Address
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Address Line | 3290 E MAYBERRY AVE
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City | GILBERT
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State | AZ
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Zip | 85297-8251
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Country | US
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Telephone | 480-274-5691
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Fax |
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Authorized Official
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Title or Position | PMHNP-BC
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Name | MARION CRISOSTOMO
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Credential | PMHNP
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Telephone | 480-274-5691
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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