MEDICARE: SARAH MOTA PMHNP

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	232856	AZ

General Provider Information

NPI Number	:	1245908219
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH MOTA PMHNP

Provider Business Mailing Address
First Line	:	PO BOX 882
Second Line	:
City	:	ORACLE
State	:	AZ
Zip	:	85623-0882
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2601 N CAMPBELL AVE STE 200
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85719-3187
Country	:	US
Telephone Number	:	520-222-8204
Fax Number	:

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

Provider Enumeration Date	:	09/02/2021
Last Update Date	:	03/15/2024

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