Healthcare Provider Details

I. General information

NPI: 1326724766
Provider Name (Legal Business Name): BRENDA KOTIZA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2023
Last Update Date: 06/22/2023
Certification Date: 06/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5040 E SHEA BLVD #164
PHOENIX AZ
85028
US

IV. Provider business mailing address

6356 E OSBORN RD
SCOTTSDALE AZ
85251-5451
US

V. Phone/Fax

Practice location:
  • Phone: 480-641-1165
  • Fax:
Mailing address:
  • Phone: 480-244-0189
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: