Healthcare Provider Details

I. General information

NPI: 1265107221
Provider Name (Legal Business Name): MAKAYLA IRENE BABISH PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2021
Last Update Date: 08/11/2021
Certification Date: 08/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6130 E BROWN RD
MESA AZ
85205-4960
US

IV. Provider business mailing address

11887 N 113TH ST
SCOTTSDALE AZ
85259-3116
US

V. Phone/Fax

Practice location:
  • Phone: 480-807-3554
  • Fax:
Mailing address:
  • Phone: 308-280-0802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number8574
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: