Healthcare Provider Details

I. General information

NPI: 1710800099
Provider Name (Legal Business Name): JENNIFER OLAGUE CARRANZA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12100 N DYSART RD
EL MIRAGE AZ
85335
US

IV. Provider business mailing address

12513 W WINDROSE DR
EL MIRAGE AZ
85335-6210
US

V. Phone/Fax

Practice location:
  • Phone: 602-887-0706
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: