Healthcare Provider Details

I. General information

NPI: 1912821281
Provider Name (Legal Business Name): MCKINNA COBB
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35293 N GANTZEL RD STE B
SAN TAN VALLEY AZ
85143-5171
US

IV. Provider business mailing address

41929 N SUBURBAN AVE
SAN TAN VALLEY AZ
85140-1000
US

V. Phone/Fax

Practice location:
  • Phone: 602-887-1083
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: