Provider Demographics
NPI:1497947816
Name:CONKLIN, MARIA (COTA)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:
Last Name:CONKLIN
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13835 N TATUM BLVD
Mailing Address - Street 2:STE 9-429
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-5590
Mailing Address - Country:US
Mailing Address - Phone:480-204-7475
Mailing Address - Fax:602-633-1076
Practice Address - Street 1:4113 W ORAIBI DR
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-7424
Practice Address - Country:US
Practice Address - Phone:602-614-6683
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-10
Last Update Date:2015-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1744174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist