Individual
DAISY CORAL MATEO ANTUNA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4041 N CENTRAL AVE BLDG C, PHOENIX, AZ 85012-3313
(602) 279-5351
Mailing address
4041 N CENTRAL AVE BLDG C, PHOENIX, AZ 85012-3313
(602) 279-5351
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
D10847152
AZ
101Y00000X
Counselor
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1303295
—
MA
05
—
1307576
—
MA
01
—
M18463
BLUE CROSS BLUE SHIELD
MA
Enumeration date
08/12/2015
Last updated
02/10/2021
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