MEDICARE: MRS. RABIYA M. TROTTER

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	251S00000X	Community/Behavioral Health Agency	BH5381

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	BH5381	OTHER	AZ	ARIZONA DEPARTMENT OF HEALTH SERVICES

General Provider Information

NPI Number	:	1629570379
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. RABIYA M. TROTTER

Provider Business Mailing Address
First Line	:	4051 E GAIL CT
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85296-9646
Country	:	US
Telephone Number	:	480-862-4855
Fax Number	:

Provider Business Practice Location Address
First Line	:	41288 N CAMBRIA DR
Second Line	:
City	:	SAN TAN VALLEY
State	:	AZ
Zip	:	85140-3173
Country	:	US
Telephone Number	:	480-862-4855
Fax Number	:

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

Provider Enumeration Date	:	03/07/2018
Last Update Date	:	03/07/2018

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