Healthcare Provider Details

I. General information

NPI: 1447004734
Provider Name (Legal Business Name): MABEL TOBAH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2024
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4410 E UNIVERSITY DR STE 104
MESA AZ
85205-7104
US

IV. Provider business mailing address

3003 E MEGAN ST
GILBERT AZ
85295-0416
US

V. Phone/Fax

Practice location:
  • Phone: 480-401-9939
  • Fax:
Mailing address:
  • Phone: 480-593-7335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number306027
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: