Provider Demographics
NPI:1487750550
Name:A PRIVATE AFFAIR DIANA'S SPECIALTY SHOP
Entity type:Organization
Organization Name:A PRIVATE AFFAIR DIANA'S SPECIALTY SHOP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:MAY
Authorized Official - Last Name:IRWIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-345-6141
Mailing Address - Street 1:2090 N DOBSON RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-2394
Mailing Address - Country:US
Mailing Address - Phone:480-345-6141
Mailing Address - Fax:480-345-2641
Practice Address - Street 1:2090 N DOBSON RD
Practice Address - Street 2:SUITE 1
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-2394
Practice Address - Country:US
Practice Address - Phone:480-345-6141
Practice Address - Fax:480-345-2641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ5164240001Medicare ID - Type UnspecifiedPROVIDER IDENTIFICATION