Individual
MRS. GEORGETA MOISIU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
13535 W CANYON CREEK DR, SURPRISE, AZ 85374-5407
(623) 594-2294
(623) 328-7031
Mailing address
13535 W CANYON CREEK DR, SURPRISE, AZ 85374-5407
(623) 594-2294
(623) 328-7031
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
AL6904H
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
572046
AHCCCS
AZ
Enumeration date
07/18/2011
Last updated
07/18/2011
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