Provider Demographics
NPI:1952863011
Name:CAMPOY, MARIAH ROSE
Entity Type:Individual
Prefix:MS
First Name:MARIAH
Middle Name:ROSE
Last Name:CAMPOY
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 1:4036 W BLUEFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-1813
Mailing Address - Country:US
Mailing Address - Phone:602-435-9515
Mailing Address - Fax:
Practice Address - Street 1:4232 W BELL RD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-4027
Practice Address - Country:US
Practice Address - Phone:623-465-6360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-05
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0007621363A00000X
363A00000X
WAPA61373859363A00000X
GA11876363A00000X
AZ7604363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant