Healthcare Provider Details

I. General information

NPI: 1003113531
Provider Name (Legal Business Name): PAULINA ELISE MARIKI-MHANGO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PAULINA ELISE MARIKI MD

II. Dates (important events)

Enumeration Date: 02/18/2011
Last Update Date: 03/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15351 W BELL RD
SURPRISE AZ
85374-4580
US

IV. Provider business mailing address

9744 W NORTHERN AVE #1310
PEORIA AZ
85345-4603
US

V. Phone/Fax

Practice location:
  • Phone: 623-583-3001
  • Fax:
Mailing address:
  • Phone: 623-776-7500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number49384
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License Number49384
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: