Individual
MS. DIANE MACON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1910 E MOBILE LN, PHOENIX, AZ 85040-2439
(602) 268-4333
Mailing address
PO BOX 8552, PHOENIX, AZ 85066
(602) 268-4333
Taxonomy
Speciality
Code
Description
License number
State
385HR2055X
Child Mental Illness Respite Care
Primary
3870
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
714221
AHCCCS ID NUMBER
AZ
Enumeration date
11/27/2006
Last updated
07/08/2007
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