Healthcare Provider Details

I. General information

NPI: 1407770134
Provider Name (Legal Business Name): MIRIAM RAQUEL FITZGERALD
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7055 W BELL RD STE B5
GLENDALE AZ
85308-8544
US

IV. Provider business mailing address

8835 W JOHN CABOT RD
PEORIA AZ
85382-0819
US

V. Phone/Fax

Practice location:
  • Phone: 720-961-3764
  • Fax:
Mailing address:
  • Phone: 206-530-8080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: