Individual
MARISTELA Y NABONG-NILLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1705 W MAIN ST, MESA, AZ 85201-6920
(623) 583-3001
Mailing address
3033 N CENTRAL AVE STE 145, PHOENIX, AZ 85012-2808
(623) 583-3001
(623) 583-3007
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
30745
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
082796
—
AZ
05
—
307457
—
SC
05
—
6961002
—
NJ
Enumeration date
11/01/2006
Last updated
01/11/2021
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