Provider Demographics
NPI:1831638394
Name:FELIX, MIRTHA
Entity Type:Individual
Prefix:
First Name:MIRTHA
Middle Name:
Last Name:FELIX
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 1:6301 W EARLL DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85033-5717
Mailing Address - Country:US
Mailing Address - Phone:480-233-6481
Mailing Address - Fax:623-398-8909
Practice Address - Street 1:6301 W EARLL DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85033-5717
Practice Address - Country:US
Practice Address - Phone:480-233-6481
Practice Address - Fax:623-398-8909
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-16
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAL10093H310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility