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: 06/27/2023
Certification Date: 06/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 S 8TH AVE STE 200
YUMA AZ
85364-7158
US

IV. Provider business mailing address

2400 S AVENUE A
YUMA AZ
85364-7127
US

V. Phone/Fax

Practice location:
  • Phone: 928-336-7095
  • Fax:
Mailing address:
  • Phone: 928-336-7095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number1908R80537
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: