=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407409782
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DESIREE ANDREA ARIAS CNM
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/16/2019
-----------------------------------------------------
Last Update Date | 07/16/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14239 W BELL RD STE 210
-----------------------------------------------------
City | SURPRISE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85374-2471
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 623-584-0800
-----------------------------------------------------
Fax | 623-584-0312
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15296 W REDFIELD RD
-----------------------------------------------------
City | SURPRISE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85379-8018
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 623-466-4335
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 367A00000X
-----------------------------------------------------
Taxonomy Name | Advanced Practice Midwife
-----------------------------------------------------
License Number | 228588
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------