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General NPI Number Information
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NPI Number | 1245222074
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Entity Type | Individual
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Provider Name | KAREN MARIE ACEVEDO-MOGHARBEL D.O
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Gender | Female
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Dates
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Enumeration Date | 08/18/2005
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Last Update Date | 03/09/2009
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Provider Practice Location Address
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Address Line | 3035 S ELLSWORTH RD SUITE 103
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City | MESA
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State | AZ
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Zip | 85212
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Country | US
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Telephone | 480-736-1777
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Fax | 480-736-1144
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Provider Business Mailing Address
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Address Line | 3035 S ELLSWORTH RD SUITE 103
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City | MESA
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State | AZ
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Zip | 85212-2160
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Country | US
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Telephone | 480-736-1777
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Fax | 480-736-1144
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 3882
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License Number State | AZ
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