Healthcare Provider Details

I. General information

NPI: 1689251696
Provider Name (Legal Business Name): MAUREEN KARINA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2021
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17215 N 72ND DR STE A105
GLENDALE AZ
85308-8557
US

IV. Provider business mailing address

17215 N 72ND DR STE A105
GLENDALE AZ
85308-8557
US

V. Phone/Fax

Practice location:
  • Phone: 480-393-3515
  • Fax:
Mailing address:
  • Phone: 559-624-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number72749
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number7480
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: