Healthcare Provider Details

I. General information

NPI: 1861319675
Provider Name (Legal Business Name): MAIRA PEREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 W 10TH ST STE 2
CASA GRANDE AZ
85122-3940
US

IV. Provider business mailing address

PO BOX 833
STANFIELD AZ
85172-1627
US

V. Phone/Fax

Practice location:
  • Phone: 520-677-5554
  • Fax:
Mailing address:
  • Phone: 520-485-9711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT-22888
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: