Provider Demographics
NPI:1437690286
Name:MARISCAL, ROSA IDALIA
Entity Type:Individual
Prefix:
First Name:ROSA
Middle Name:IDALIA
Last Name:MARISCAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9453 E WOOD DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-4365
Mailing Address - Country:US
Mailing Address - Phone:213-268-1457
Mailing Address - Fax:
Practice Address - Street 1:6320 N 82ND ST
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85250-5611
Practice Address - Country:US
Practice Address - Phone:480-484-3111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-13
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN145811163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse