Basic Information
| Provider Information | |||||||||
| NPI: | 1497900260 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DIMAURO | ||||||||
| FirstName: | PREMA | ||||||||
| MiddleName: | HELEN | ||||||||
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| Credential: | PTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3051 SUNFLOWER CIR W | ||||||||
| Address2: | |||||||||
| City: | PALM SPRINGS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 922621773 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7604169838 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7540 N 19TH AVE STE 200 | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850217967 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8888734221 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/20/2008 | ||||||||
| LastUpdateDate: | 11/20/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | AT3119 | CA | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility | 314000000X | AT 3119 | CA | N | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.