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General NPI Number Information
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NPI Number | 1598672263
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Entity Type | Organization
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Legal Business Name | MISSION KIDZ GROUP
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Dates
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Enumeration Date | 08/26/2026
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Last Update Date | 08/26/2026
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Provider Practice Location Address
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Address Line | 2198 E CAMELBACK RD SUITE 270
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City | PHOENIX
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State | AZ
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Zip | 85016
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Country | US
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Telephone | 623-282-4742
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Fax |
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Provider Business Mailing Address
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Address Line | 15411 W WADDELL RD STE 102
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City | SURPRISE
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State | AZ
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Zip | 85379-5170
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Country | US
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Telephone | 623-282-4742
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. JONATHAN DAVID VICENTE
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Credential |
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Telephone | 480-383-9503
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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