Healthcare Provider Details

I. General information

NPI: 1912541129
Provider Name (Legal Business Name): PAULINA NWADAODU CHIGBU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2019
Last Update Date: 06/26/2023
Certification Date: 06/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2669 N 73RD DR
PHOENIX AZ
85035-3253
US

IV. Provider business mailing address

2669 N 73RD DR
PHOENIX AZ
85035-3253
US

V. Phone/Fax

Practice location:
  • Phone: 602-769-3458
  • Fax:
Mailing address:
  • Phone: 602-769-3458
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License NumberBH5909
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberBH5909
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: