Individual
MINERVA MARLENE POUCHOULEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5850 E STILL CIR, MESA, AZ 85206-3618
(480) 219-6000
Mailing address
5850 E STILL CIR, MESA, AZ 85206-3618
(480) 219-6000
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA60959
CA
Other
Enumeration date
08/23/2019
Last updated
02/07/2023
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