Healthcare Provider Details

I. General information

NPI: 1639560816
Provider Name (Legal Business Name): ROSE MARIE MINTZ PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2015
Last Update Date: 05/16/2023
Certification Date: 05/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9015 N 3RD ST
PHOENIX AZ
85020-2444
US

IV. Provider business mailing address

312 N ALMA SCHOOL RD STE 11
CHANDLER AZ
85224-4354
US

V. Phone/Fax

Practice location:
  • Phone: 480-882-4545
  • Fax: 602-714-3755
Mailing address:
  • Phone: 623-300-5477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5991
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: