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General NPI Number Information
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NPI Number | 1275486607
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Entity Type | Individual
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Provider Name | JAZMIN PENALOZA MATA
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Gender | Female
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Dates
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Enumeration Date | 02/16/2026
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Last Update Date | 02/17/2026
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Provider Practice Location Address
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Address Line | 15525 N 83RD AVE STE 104
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City | PEORIA
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State | AZ
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Zip | 85382-5820
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Country | US
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Telephone | 480-964-2273
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Fax |
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Provider Business Mailing Address
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Address Line | 7562 N 125TH AVE
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City | GLENDALE
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State | AZ
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Zip | 85307-1745
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Country | US
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Telephone |
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Fax |
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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 | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | H010881
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License Number State | AZ
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