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General NPI Number Information
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NPI Number | 1912547860
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Entity Type | Individual
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Provider Name | ERNESTA PEARL
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Gender | Female
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Dates
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Enumeration Date | 01/08/2020
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Last Update Date | 01/08/2020
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Provider Practice Location Address
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Address Line | 13614 N 89TH ST
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City | SCOTTSDALE
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State | AZ
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Zip | 85260-7653
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Country | US
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Telephone | 480-823-8848
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Fax |
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Provider Business Mailing Address
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Address Line | 7028 S 58TH AVE
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City | LAVEEN
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State | AZ
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Zip | 85339-2265
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Country | US
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Telephone | 480-823-8848
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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 | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | BH5958
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License Number State | AZ
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