Healthcare Provider Details

I. General information

NPI: 1770128514
Provider Name (Legal Business Name): MARIA KARINA MIJARES RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2019
Last Update Date: 11/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18391 W STATLER ST
SURPRISE AZ
85388-1806
US

IV. Provider business mailing address

13096 N 147TH CT
SURPRISE AZ
85379-4224
US

V. Phone/Fax

Practice location:
  • Phone: 623-440-8362
  • Fax: 623-440-8364
Mailing address:
  • Phone: 602-710-5742
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN138715
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: