Provider Demographics
NPI:1588225874
Name:SILLAS, MARIA D (CARE SUPERVISOR)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:D
Last Name:SILLAS
Suffix:
Gender:F
Credentials:CARE SUPERVISOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5605 W LYDIA LN
Mailing Address - Street 2:
Mailing Address - City:LAVEEN
Mailing Address - State:AZ
Mailing Address - Zip Code:85339-4208
Mailing Address - Country:US
Mailing Address - Phone:623-800-6170
Mailing Address - Fax:
Practice Address - Street 1:7106 N 35TH AVE STE 205
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85051-8355
Practice Address - Country:US
Practice Address - Phone:623-800-6170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-26
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty