Healthcare Provider Details

I. General information

NPI: 1598672263
Provider Name (Legal Business Name): MISSION KIDZ GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2198 E CAMELBACK RD SUITE 270
PHOENIX AZ
85016
US

IV. Provider business mailing address

15411 W WADDELL RD STE 102
SURPRISE AZ
85379-5170
US

V. Phone/Fax

Practice location:
  • Phone: 623-282-4742
  • Fax:
Mailing address:
  • Phone: 623-282-4742
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: MR. JONATHAN DAVID VICENTE
Title or Position: OWNER
Credential:
Phone: 480-383-9503