Individual
SUSAN MARITA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
7335 E JUNE ST, MESA, AZ 85207-2959
(602) 427-8235
Mailing address
7335 E JUNE ST, MESA, AZ 85207-2959
(602) 427-8235
Taxonomy
Speciality
Code
Description
License number
State
385H00000X
Respite Care
Primary
BH4950
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
BH4950
AZ DHS LICENSE
AZ
Enumeration date
09/02/2016
Last updated
09/02/2016
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