Individual
ROGER M MAYORGA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
APN
Contact information
Practice address
40 E MITCHELL DR, SUITE 100 & 200, PHOENIX, AZ 85012-2330
(602) 808-5800
(602) 248-7993
Mailing address
202 E EARLL DR, SUITE 200, PHOENIX, AZ 85012-2634
(602) 808-2800
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
AP8136
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
269427
—
AZ
Enumeration date
10/16/2006
Last updated
10/08/2019
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