Healthcare Provider Details

I. General information

NPI: 1417309923
Provider Name (Legal Business Name): PRETTY MALOKERA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2016
Last Update Date: 06/20/2024
Certification Date: 06/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12418 WEST ORANGEWOOD AVE
GLENDALE AZ
85307
US

IV. Provider business mailing address

1755 NORTH PEBBLECREEK PKWY
GOODYEAR AZ
85395
US

V. Phone/Fax

Practice location:
  • Phone: 623-385-2039
  • Fax:
Mailing address:
  • Phone: 623-385-2039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code224ZF0002X
TaxonomyFeeding, Eating & Swallowing Occupational Therapy Assistant
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code225CA2400X
TaxonomyAssistive Technology Practitioner Rehabilitation Counselor
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code225CA2500X
TaxonomyAssistive Technology Supplier Rehabilitation Counselor
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 8
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 9
Primary TaxonomyN
Taxonomy Code225XF0002X
TaxonomyFeeding, Eating & Swallowing Occupational Therapist
License Number
License Number State
# 10
Primary TaxonomyN
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number
License Number State
# 11
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: ELIANITA S DE PAULA
Title or Position: OWNER/CEO
Credential: BSLPA, MSED
Phone: 623-385-2039