Individual
CERAINA HULL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
8430 E KEATS AVE, MESA, AZ 85209-4345
(480) 584-0304
Mailing address
8430 E KEATS AVE, MESA, AZ 85209-4345
Taxonomy
Speciality
Code
Description
License number
State
385HR2055X
Child Mental Illness Respite Care
Primary
4498478
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4498478
AZ DEPT OF HEALTH SERVICES
AZ
Enumeration date
07/25/2019
Last updated
07/25/2019
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