Healthcare Provider Details

I. General information

NPI: 1285460626
Provider Name (Legal Business Name): ANA MARIA TITEN BELEN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2024
Last Update Date: 09/25/2024
Certification Date: 09/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 E BELL RD STE 119
PHOENIX AZ
85022-6639
US

IV. Provider business mailing address

7330 N 16TH ST STE B101
PHOENIX AZ
85020-5274
US

V. Phone/Fax

Practice location:
  • Phone: 602-358-8588
  • Fax:
Mailing address:
  • Phone: 602-358-8588
  • Fax: 602-688-6991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10134
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: