Provider Demographics
NPI:1730567801
Name:AROCKIARAJ, CICILI (NP)
Entity type:Individual
Prefix:
First Name:CICILI
Middle Name:
Last Name:AROCKIARAJ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:CICILI
Other - Middle Name:
Other - Last Name:AROCKIARAJ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:19401 N CAVE CREEK RD STE 18
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85024-1825
Mailing Address - Country:US
Mailing Address - Phone:602-996-0099
Mailing Address - Fax:602-996-0099
Practice Address - Street 1:4136 N 75TH AVE STE 116
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85033-3100
Practice Address - Country:US
Practice Address - Phone:623-247-1234
Practice Address - Fax:623-247-4231
Is Sole Proprietor?:No
Enumeration Date:2015-05-11
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ126288363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZD03974937Medicare PIN