Healthcare Provider Details

I. General information

NPI: 1932038775
Provider Name (Legal Business Name): MAURICIO ALEJANDRO ALVARADO MIRA M.D.
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ST. JOSEPH'S HOSPITAL AND MEDICAL CENTER 350 W THOMAS RD
PHOENIX AZ
85013
US

IV. Provider business mailing address

CREIGHTON UNIVERSITY 3100 N. CENTRAL AVENUE
PHOENIX AZ
85012
US

V. Phone/Fax

Practice location:
  • Phone: 602-406-3000
  • Fax:
Mailing address:
  • Phone: 602-812-4312
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: