Healthcare Provider Details

I. General information

NPI: 1952976896
Provider Name (Legal Business Name): SVETIANA MIJALSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2021
Last Update Date: 05/24/2021
Certification Date: 05/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9326 W LOUISE DR
PEORIA AZ
85383-2960
US

IV. Provider business mailing address

17313 N 19TH TER
PHOENIX AZ
85022-8100
US

V. Phone/Fax

Practice location:
  • Phone: 602-290-3584
  • Fax:
Mailing address:
  • Phone: 602-290-3584
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376G00000X
TaxonomyNursing Home Administrator
License NumberAL114G1H
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: