Organization
MARIPOSA COMMUNITY HEALTH CENTER, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMY TAYLOR (CHIEF EXECUTIVE OFFICER)
(520) 761-2128
Entity
Organization
Contact information
Practice address
1852 N MASTICK WAY, NOGALES, AZ 85621-1063
(520) 281-1550
(520) 281-4487
Mailing address
825 N GRAND AVE STE 100, NOGALES, AZ 85621-2385
(520) 761-2128
(520) 281-1112
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
1223D0001X
Public Health Dentistry
—
—
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
—
—
163W00000X
Registered Nurse
—
—
164W00000X
Licensed Practical Nurse
—
—
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
208000000X
Pediatrics Physician
—
—
2085R0202X
Diagnostic Radiology Physician
—
—
2085U0001X
Diagnostic Ultrasound Physician
—
—
208600000X
Surgery Physician
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
031812
MEDICARE PART A GROUP #
AZ
05
—
931845
—
AZ
01
—
ZFQ31812
MEDICARE PART B GROUP #
AZ
Enumeration date
06/29/2006
Last updated
02/10/2025
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