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General NPI Number Information
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NPI Number | 1073373536
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Entity Type | Organization
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Legal Business Name | MARIPOSA COMMUNITY HEALTH CENTER, INC
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Dates
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Enumeration Date | 03/21/2024
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Last Update Date | 02/17/2025
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Provider Practice Location Address
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Address Line | 1103 CIRCULO MERCADO
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City | RIO RICO
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State | AZ
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Zip | 85648-6248
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Country | US
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Telephone | 520-375-5032
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Fax | 520-761-2159
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Provider Business Mailing Address
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Address Line | 825 N GRAND AVE STE 100
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City | NOGALES
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State | AZ
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Zip | 85621-1061
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Country | US
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Telephone | 520-761-2133
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Fax | 520-281-1112
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | AMY TAYLOR
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Credential |
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Telephone | 520-761-2128
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223D0001X
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Taxonomy Name | Public Health Dentistry
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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