Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 30997 | AZ |
NPI | 1114941135 |
---|---|
Provider Name | Dr. Maria Mercedes Alba |
First Address | Casa Grande, AZ 85130-0020 |
Second Address | Casa Grande, AZ 85122-5303 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2006 |
Last Update Date | 02/05/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
847574 | (05) | AZ |