Provider Demographics
NPI:1548336811
Name:DARADICI, JODI
Entity type:Individual
Prefix:MRS
First Name:JODI
Middle Name:
Last Name:DARADICI
Suffix:
Gender:F
Credentials:
Other - Prefix:MR
Other - First Name:ROBERT
Other - Middle Name:
Other - Last Name:DARADICI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:16610 N 19TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85022-6259
Mailing Address - Country:US
Mailing Address - Phone:602-795-3971
Mailing Address - Fax:
Practice Address - Street 1:16610 N 19TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85022-6259
Practice Address - Country:US
Practice Address - Phone:602-795-3971
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5810385HR2055X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ825713OtherAHCCCS ID NUMBER