Healthcare Provider Details

I. General information

NPI: 1629652490
Provider Name (Legal Business Name): HABIBA DJUMAPILI MAULIDI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2021
Last Update Date: 05/07/2021
Certification Date: 05/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18444 N 25TH AVE STE 420
PHOENIX AZ
85023-1268
US

IV. Provider business mailing address

18444 N 25TH AVE STE 420
PHOENIX AZ
85023-1268
US

V. Phone/Fax

Practice location:
  • Phone: 480-534-0605
  • Fax:
Mailing address:
  • Phone: 480-534-0605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: