Healthcare Provider Details

I. General information

NPI: 1174622914
Provider Name (Legal Business Name): JEAN MULLEN M.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JEAN BIANCO

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 07/28/2020
Certification Date: 07/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6285 S HIGLEY RD
GILBERT AZ
85298-4262
US

IV. Provider business mailing address

6285 S HIGLEY RD
GILBERT AZ
85298-4262
US

V. Phone/Fax

Practice location:
  • Phone: 480-480-4949
  • Fax: 480-460-5858
Mailing address:
  • Phone: 480-480-4949
  • Fax: 480-460-5858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number30553
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: