Individual
ALICE MBUTHIA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2663 E OMEGA DR, SAN TAN VALLEY, AZ 85143-4625
(480) 452-5318
Mailing address
2663 E OMEGA DR, SAN TAN VALLEY, AZ 85143-4625
Taxonomy
Speciality
Code
Description
License number
State
385H00000X
Respite Care
Primary
BH5527
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
BH5527
AZ DEPT OF HEALTH SERVICES
AZ
Enumeration date
12/27/2018
Last updated
12/27/2018
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