Provider Demographics
NPI:1578306742
Name:ENCARNADO, GRAZIELLA
Entity type:Individual
Prefix:
First Name:GRAZIELLA
Middle Name:
Last Name:ENCARNADO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15826 N 10TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85022-3144
Mailing Address - Country:US
Mailing Address - Phone:602-296-4057
Mailing Address - Fax:602-283-5897
Practice Address - Street 1:15826 N 10TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85022-3144
Practice Address - Country:US
Practice Address - Phone:602-296-4057
Practice Address - Fax:602-283-5897
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-17
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAL12733H310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility