Healthcare Provider Details

I. General information

NPI: 1154196756
Provider Name (Legal Business Name): MADELINE PATRICIA MAROTTA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MADDIE MAROTTA

II. Dates (important events)

Enumeration Date: 11/24/2023
Last Update Date: 07/18/2025
Certification Date: 07/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1492 S MILL AVE STE 101
TEMPE AZ
85281-5660
US

IV. Provider business mailing address

1492 S MILL AVE STE 101
TEMPE AZ
85281-5660
US

V. Phone/Fax

Practice location:
  • Phone: 480-834-7546
  • Fax:
Mailing address:
  • Phone: 480-834-7546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10074
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: