Healthcare Provider Details

I. General information

NPI: 1578074134
Provider Name (Legal Business Name): BIANCA PILAR GARCIA KENDALL FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2017
Last Update Date: 10/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6130 E BROWN RD STE 101
MESA AZ
85205-4960
US

IV. Provider business mailing address

4545 E SOUTHERN AVE STE 103
MESA AZ
85206-2677
US

V. Phone/Fax

Practice location:
  • Phone: 480-807-3554
  • Fax:
Mailing address:
  • Phone: 480-981-6100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP10149
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: