Healthcare Provider Details

I. General information

NPI: 1437819554
Provider Name (Legal Business Name): ARON MIXSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/30/2021
Last Update Date: 12/30/2021
Certification Date: 12/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1155 W ELLIOT RD APT 2128
TEMPE AZ
85284-1173
US

IV. Provider business mailing address

1155 W ELLIOT RD APT 2128
TEMPE AZ
85284-1173
US

V. Phone/Fax

Practice location:
  • Phone: 480-334-7540
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code342000000X
TaxonomyTransportation Network Company
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: