Healthcare Provider Details

I. General information

NPI: 1164340287
Provider Name (Legal Business Name): LYDIA SANABRIA MBM, MAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

13980 N 67TH AVE STE 1
GLENDALE AZ
85306-3715
US

IV. Provider business mailing address

13980 N 67TH AVE STE 1
GLENDALE AZ
85306-3715
US

V. Phone/Fax

Practice location:
  • Phone: 623-499-5920
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: