Healthcare Provider Details

I. General information

NPI: 1831742618
Provider Name (Legal Business Name): MISTY VILLAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2019
Last Update Date: 07/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 S DOBSON RD
MESA AZ
85202-4707
US

IV. Provider business mailing address

5525 W COLES RD
LAVEEN AZ
85339-5254
US

V. Phone/Fax

Practice location:
  • Phone: 480-412-4100
  • Fax:
Mailing address:
  • Phone: 602-318-0145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number229681
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: