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General NPI Number Information
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NPI Number | 1740311976
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Entity Type | Individual
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Provider Name | HEATHER CHAKOS MULNO M.S.-CSP
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Gender | Female
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Dates
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Enumeration Date | 03/08/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4650 WEST SWEETWATER AVENUE SPECIAL SERVICES
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City | GLENDALE
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State | AZ
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Zip | 85304
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Country | US
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Telephone | 602-347-2653
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Fax |
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Provider Business Mailing Address
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Address Line | 826 W HOWE ST
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City | TEMPE
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State | AZ
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Zip | 85281-5428
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Country | US
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Telephone | 480-664-7667
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State | CA
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