Healthcare Provider Details

I. General information

NPI: 1174040802
Provider Name (Legal Business Name): MARIA AZUCENA MARTINEZ BERBER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2017
Last Update Date: 01/22/2026
Certification Date: 01/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4340 E INDIAN SCHOOL RD STE 21-194
PHOENIX AZ
85018-5360
US

IV. Provider business mailing address

4340 E INDIAN SCHOOL RD STE 21-194
PHOENIX AZ
85018-5360
US

V. Phone/Fax

Practice location:
  • Phone: 480-251-9000
  • Fax: 480-427-0704
Mailing address:
  • Phone: 480-251-9000
  • Fax: 480-427-0704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBEH-001759
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: