Individual
EDGAR MAYORQUIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
1896 E BABBITT LN, SAN LUIS, AZ 85349
(928) 722-6112
(928) 722-6113
Mailing address
PO BOX 617, SOMERTON, AZ 85350-0617
(928) 662-0406
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
AP11434
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
AZ
Enumeration date
06/27/2018
Last updated
08/19/2024
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