Individual
CHANTAL MADIATA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3641 W BELLEWOOD PL, TUCSON, AZ 85741-5407
(520) 351-9952
Mailing address
994 S HARRISON RD, TUCSON, AZ 85748-6608
(520) 721-1887
(520) 721-0069
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
BH4643
AZ
385H00000X
Respite Care
Primary
BH5270
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
BH5270
AZ DEPT OF HEALTH SERVICES
AZ
Enumeration date
06/16/2015
Last updated
09/04/2020
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