Healthcare Provider Details

I. General information

NPI: 1376141515
Provider Name (Legal Business Name): DANIEL JOSEPH MIZELL PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2020
Last Update Date: 02/13/2023
Certification Date: 02/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12665 W SMOKEY DR STE 140
SURPRISE AZ
85378-3732
US

IV. Provider business mailing address

5601 W EUGIE AVE STE 100
GLENDALE AZ
85304-1256
US

V. Phone/Fax

Practice location:
  • Phone: 623-219-4040
  • Fax:
Mailing address:
  • Phone: 602-298-8888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number8196
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: