Provider Demographics
NPI:1396890612
Name:VERDEJO, NATIVIDAD (MD)
Entity type:Individual
Prefix:DR
First Name:NATIVIDAD
Middle Name:
Last Name:VERDEJO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6218
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85246-6218
Mailing Address - Country:US
Mailing Address - Phone:480-855-3770
Mailing Address - Fax:480-855-7906
Practice Address - Street 1:2360 W RAY RD STE 2
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-3516
Practice Address - Country:US
Practice Address - Phone:480-855-3770
Practice Address - Fax:480-855-7906
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2011-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ22684207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ187395Medicaid
AZ22684MDMedicare ID - Type UnspecifiedMEDICARE ID
AZ187395Medicaid