Individual
IMELDA SIONGCO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1432 N. DE SOTO ST., CHANDLER, AZ 85224-7850
(480) 755-4390
Mailing address
529 N SAGUARO ST, CHANDLER, AZ 85224-4283
(480) 600-6818
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
AL8867
AZ
311ZA0620X
Adult Care Home Facility
AL9060
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
825596
—
AZ
05
—
825613
—
AZ
Enumeration date
07/20/2015
Last updated
07/20/2015
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