Healthcare Provider Details

I. General information

NPI: 1235776204
Provider Name (Legal Business Name): MCA MEDICAL, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2019
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20033 N 19TH AVE STE 1-100
PHOENIX AZ
85027-4245
US

IV. Provider business mailing address

PO BOX 9080
SURPRISE AZ
85374-0134
US

V. Phone/Fax

Practice location:
  • Phone: 480-257-1950
  • Fax: 713-510-1548
Mailing address:
  • Phone: 623-974-6611
  • Fax: 623-974-9434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0011X
TaxonomyUndersea and Hyperbaric Medicine (Preventive Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: BERNADINE MOIRA SYKSTUS
Title or Position: COMPLIANCE OFFICER
Credential: MHA, CPCO, CPMA, RRT
Phone: 713-301-5707