Healthcare Provider Details

I. General information

NPI: 1407532914
Provider Name (Legal Business Name): MARIA J PRINCE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2023
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2360 S AVENUE A
YUMA AZ
85364
US

IV. Provider business mailing address

2400 S AVENUE A
YUMA AZ
85364-7127
US

V. Phone/Fax

Practice location:
  • Phone: 928-336-3980
  • Fax: 928-336-3946
Mailing address:
  • Phone: 928-344-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number79435
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: