Provider Demographics
NPI:1881708261
Name:ADAM DIPUCCIO L.L.C.
Entity type:Organization
Organization Name:ADAM DIPUCCIO L.L.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:DIPUCCIO
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-AFAAA
Authorized Official - Phone:480-218-1328
Mailing Address - Street 1:5202 E. MAIN STREET
Mailing Address - Street 2:SUITE #105
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85205-8038
Mailing Address - Country:US
Mailing Address - Phone:480-218-1328
Mailing Address - Fax:480-218-1330
Practice Address - Street 1:5202 E. MAIN STREET
Practice Address - Street 2:SUITE #105
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85205-8038
Practice Address - Country:US
Practice Address - Phone:480-218-1328
Practice Address - Fax:480-218-1330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZDA2043231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1881708261OtherGROUP NPI
AZ894164Medicaid
AZZ83224Medicare UPIN