Healthcare Provider Details

I. General information

NPI: 1669352449
Provider Name (Legal Business Name): MIREYA GUADALUPE VILLALOBOS PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2025
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1860 N 95TH LN STE 300
PHOENIX AZ
85037-5074
US

IV. Provider business mailing address

1860 N 95TH LN STE 300
PHOENIX AZ
85037-5074
US

V. Phone/Fax

Practice location:
  • Phone: 480-626-7584
  • Fax:
Mailing address:
  • Phone: 480-626-7584
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number250016
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number250016
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: