Provider Demographics
NPI:1427670207
Name:VERDIEU, JAMES
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:VERDIEU
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 1:2785 W GOLDMINE MOUNTAIN DR
Mailing Address - Street 2:
Mailing Address - City:SAN TAN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-4752
Mailing Address - Country:US
Mailing Address - Phone:602-487-8998
Mailing Address - Fax:
Practice Address - Street 1:2785 W GOLDMINE MOUNTAIN DR
Practice Address - Street 2:
Practice Address - City:SAN TAN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85142-4752
Practice Address - Country:US
Practice Address - Phone:602-487-8998
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-14
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAL11416H374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide