Provider Demographics
NPI:1396184602
Name:GOOZEN-SUOR, MALIA (MS, CCP)
Entity Type:Individual
Prefix:
First Name:MALIA
Middle Name:
Last Name:GOOZEN-SUOR
Suffix:
Gender:F
Credentials:MS, CCP
Other - Prefix:
Other - First Name:MALIA
Other - Middle Name:
Other - Last Name:GOOZEN-SUOR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, CCP
Mailing Address - Street 1:7332 N 46TH CIR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85301-2257
Mailing Address - Country:US
Mailing Address - Phone:602-750-8227
Mailing Address - Fax:
Practice Address - Street 1:10930 N TATUM BLVD
Practice Address - Street 2:103
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-6069
Practice Address - Country:US
Practice Address - Phone:602-263-7600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-19
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes242T00000XTechnologists, Technicians & Other Technical Service ProvidersPerfusionist