MEDICARE: MARY JIAOCMA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2279G1100X	General Care Registered Respiratory Therapist	11499	AZ

General Provider Information

NPI Number	:	1124496088
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY JIAOCMA

Provider Business Mailing Address
First Line	:	533 W GUADALUPE RD UNIT 1067
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85210-7761
Country	:	US
Telephone Number	:	218-230-4251
Fax Number	:

Provider Business Practice Location Address
First Line	:	533 W GUADALUPE RD UNIT 1067
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85210-7761
Country	:	US
Telephone Number	:	218-230-4251
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/09/2015
Last Update Date	:	09/09/2015

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Directions to “ MARY JIAOCMA ” Practice Location

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