Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 11047 | AZ |
NPI | 1093878811 |
---|---|
Provider Name | Marylu Reyes Macabuhay |
First Address | Glendale, AZ 85308-3781 |
Second Address | Glendale, AZ 85308-3781 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2006 |
Last Update Date | 08/07/2007 |