MEDICARE: MRS. ANTHONIA N MGBARA

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	373H00000X	Day Training/Habilitation Specialist

General Provider Information

NPI Number	:	1700455169
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANTHONIA N MGBARA

Provider Business Mailing Address
First Line	:	1849 W GREENWAY RD STE 105
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85023-3474
Country	:	US
Telephone Number	:	623-251-8066
Fax Number	:	602-942-4993

Provider Business Practice Location Address
First Line	:	1849 W GREENWAY RD STE 105
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85023-3474
Country	:	US
Telephone Number	:	623-251-8066
Fax Number	:

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

Provider Enumeration Date	:	06/21/2021
Last Update Date	:	06/21/2021

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