Healthcare Provider Details

I. General information

NPI: 1922915115
Provider Name (Legal Business Name): INTEGRATED MIND AND FAMILY CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1980 S STAPLEY DR STE 221
MESA AZ
85201
US

IV. Provider business mailing address

1980 S STAPLEY DR STE 221
MESA AZ
85201
US

V. Phone/Fax

Practice location:
  • Phone: 480-705-9585
  • Fax:
Mailing address:
  • Phone: 480-705-9585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: UMA GOPAK'JMAR
Title or Position: OWNER
Credential:
Phone: 480-705-9585