Provider Demographics
NPI:1801480066
Name:DUTU, SORIN (CAREGIVER)
Entity type:Individual
Prefix:
First Name:SORIN
Middle Name:
Last Name:DUTU
Suffix:
Gender:M
Credentials:CAREGIVER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8628 N 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-4571
Mailing Address - Country:US
Mailing Address - Phone:602-678-2281
Mailing Address - Fax:602-331-3817
Practice Address - Street 1:8628 N 7TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-4571
Practice Address - Country:US
Practice Address - Phone:602-678-2281
Practice Address - Fax:602-331-3817
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-26
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAL6397H310400000X
AZS0264253336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility