Provider Demographics
NPI:1952777948
Name:DONNA PRELLBERG
Entity type:Organization
Organization Name:DONNA PRELLBERG
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:SOTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-294-6719
Mailing Address - Street 1:7245 E OSBORN RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-6443
Mailing Address - Country:US
Mailing Address - Phone:602-294-6719
Mailing Address - Fax:602-254-2278
Practice Address - Street 1:7245 E OSBORN RD
Practice Address - Street 2:SUITE 4
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-6443
Practice Address - Country:US
Practice Address - Phone:602-294-6719
Practice Address - Fax:602-254-2278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-13
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty