Organization
MOLLEN IMMUNIZATION CLINICS OF NORTH AMERICA, INC.
Active
Other names
MICONA
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. BEVERLY A WATTS (SR. VICE PRESIDENT)
(602) 264-9806
Entity
Organization
Contact information
Practice address
4602 N 16TH ST, SUITE 200, PHOENIX, AZ 85016-5189
(602) 264-9806
(602) 264-9846
Mailing address
4602 N 16TH ST, SUITE 200, PHOENIX, AZ 85016-5189
(602) 264-9806
(602) 264-9846
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
—
—
Other
Enumeration date
03/07/2007
Last updated
11/14/2007
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