Healthcare Provider Details

I. General information

NPI: 1871586834
Provider Name (Legal Business Name): MARY ISABEL BRADY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4350 N 19TH AVE SUITE #6
PHOENIX AZ
85015
US

IV. Provider business mailing address

52 E MONTEREY WAY
PHOENIX AZ
85012-2628
US

V. Phone/Fax

Practice location:
  • Phone: 602-264-9191
  • Fax: 602-532-2973
Mailing address:
  • Phone: 602-604-9500
  • Fax: 602-631-9303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberAZ3131
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: