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NPI Code Detail

MEDICARE: PAULINE DE VET BC-MT, NMT

MEDICARE: PAULINE DE VET BC-MT, NMT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225A00000XMusic Therapist15707AZ

General Provider Information

NPI Number : 1720613227
Entity Type Code : Individual
Provider Name (Legal Business Name) : PAULINE DE VET BC-MT, NMT
Provider Business Mailing Address
First Line : 7557 N DREAMY DRAW DR UNIT 225
Second Line :
City : PHOENIX
State : AZ
Zip : 85020-4656
Country : US
Telephone Number : 480-401-7333
Fax Number :
Provider Business Practice Location Address
First Line : 2702 N 3RD ST STE 1000
Second Line :
City : PHOENIX
State : AZ
Zip : 85004-4605
Country : US
Telephone Number : 602-840-6410
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/05/2020
Last Update Date : 03/05/2020

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Directions to “ PAULINE DE VET BC-MT, NMT” Practice Location

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