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Individual

MRS. COCA AIDA HADJIPENTCHEV

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
1020 W PONTIAC DR, PHOENIX, AZ 85027-5713
(623) 748-8108
(623) 466-7753
Mailing address
1020 W PONTIAC DR, PHOENIX, AZ 85027-5713
(623) 748-8108
(623) 466-7753

Taxonomy

Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
ALH-5691
AZ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
082984
AHCCCS PROVIDER ID
AZ
Enumeration date
04/04/2008
Last updated
04/04/2008
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