Provider Demographics
NPI:1063103737
Name:ORPRECIO, GILBERT MADRID
Entity type:Individual
Prefix:
First Name:GILBERT
Middle Name:MADRID
Last Name:ORPRECIO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11433 N 33RD AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-3236
Mailing Address - Country:US
Mailing Address - Phone:602-403-9235
Mailing Address - Fax:602-296-7764
Practice Address - Street 1:11433 N 33RD AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-3236
Practice Address - Country:US
Practice Address - Phone:602-403-9235
Practice Address - Fax:602-296-7764
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAL7658H310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility