Healthcare Provider Details

I. General information

NPI: 1215125885
Provider Name (Legal Business Name): DONNA DENIAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2007
Last Update Date: 10/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4626 W MOUNTAIN VIEW RD
GLENDALE AZ
85302-2609
US

IV. Provider business mailing address

4626 W MOUNTAIN VIEW RD
GLENDALE AZ
85302-2609
US

V. Phone/Fax

Practice location:
  • Phone: 602-347-3345
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberSW-10262I
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: