Individual
EMIL USVAT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
7878 E VISTA BONITA DR, SCOTTSDALE, AZ 85255-4123
(480) 419-9760
Mailing address
7352 E OVERLOOK DR, SCOTTSDALE, AZ 85255-4742
Taxonomy
Speciality
Code
Description
License number
State
376G00000X
Nursing Home Administrator
AL5663H
AZ
376J00000X
Homemaker
Primary
AL5663H
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ALM-003377
BOARD OF EXAMINERS NURSING CARE INSTITUTION ADMINISTRATORS
AZ
Enumeration date
10/16/2019
Last updated
10/16/2019
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