Healthcare Provider Details

I. General information

NPI: 1366686321
Provider Name (Legal Business Name): MARY ANN PICARDO D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2009
Last Update Date: 04/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 W PINNACLE PEAK RD
PHOENIX AZ
85027-1000
US

IV. Provider business mailing address

PO BOX 45019
PHOENIX AZ
85064-5019
US

V. Phone/Fax

Practice location:
  • Phone: 623-869-9050
  • Fax: 623-869-9486
Mailing address:
  • Phone: 623-869-9050
  • Fax: 623-869-9486

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number1586
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: