Provider Demographics
NPI:1679770812
Name:POPA, OTILIA
Entity type:Individual
Prefix:MRS
First Name:OTILIA
Middle Name:
Last Name:POPA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 W PORT ROYALE LN
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85023-5298
Mailing Address - Country:US
Mailing Address - Phone:602-375-1670
Mailing Address - Fax:602-375-1396
Practice Address - Street 1:901 W PORT ROYALE LN
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85023-5298
Practice Address - Country:US
Practice Address - Phone:602-375-1670
Practice Address - Fax:602-375-1396
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider