Provider Demographics
NPI:1023630175
Name:P. DEANDA MEDICAL PLLC
Entity type:Organization
Organization Name:P. DEANDA MEDICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FNP-C
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:DEANDA
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:520-465-8373
Mailing Address - Street 1:1950 W PASEO MONSERRAT
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-1329
Mailing Address - Country:US
Mailing Address - Phone:520-465-8373
Mailing Address - Fax:
Practice Address - Street 1:1950 W PASEO MONSERRAT
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-1329
Practice Address - Country:US
Practice Address - Phone:520-465-8373
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-12
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility