Healthcare Provider Details

I. General information

NPI: 1285577825
Provider Name (Legal Business Name): MIA URIBE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2026
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14602 N 19TH AVE UNIT 161
PHOENIX AZ
85023-7112
US

IV. Provider business mailing address

14602 N 19TH AVE UNIT 161
PHOENIX AZ
85023-7112
US

V. Phone/Fax

Practice location:
  • Phone: 480-290-4529
  • Fax:
Mailing address:
  • Phone: 480-290-4529
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code385HR2055X
TaxonomyChild Mental Illness Respite Care
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: