Basic Information
Provider Information
NPI: 1699728576
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: OIZUMI
FirstName: JOELLE
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: PH.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 6950 E WILLIAMS FIELD RD
Address2:  
City: MESA
State: AZ
PostalCode: 852126033
CountryCode: US
TelephoneNumber: 6022775551
FaxNumber:  
Practice Location
Address1: 6950 E WILLIAMS FIELD RD
Address2:  
City: MESA
State: AZ
PostalCode: 852126033
CountryCode: US
TelephoneNumber: 6022775551
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/19/2006
LastUpdateDate: 04/15/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
103TC0700X3249AZY Behavioral Health & Social Service ProvidersPsychologistClinical

No ID Information.


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