Healthcare Provider Details

I. General information

NPI: 1164740932
Provider Name (Legal Business Name): MS. DOROTHY AYOBAMI WORIKA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MIRABERC SENIOR CARE SERVICES

II. Dates (important events)

Enumeration Date: 05/04/2010
Last Update Date: 03/22/2023
Certification Date: 03/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 E UNIVERSITY DR
TEMPE AZ
85281-1091
US

IV. Provider business mailing address

1144 65TH ST STE F
OAKLAND CA
94608-1053
US

V. Phone/Fax

Practice location:
  • Phone: 623-624-8280
  • Fax:
Mailing address:
  • Phone: 510-929-1400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number876378
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1024879
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number260581
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: