Provider Demographics
NPI:1336851245
Name:MADRIGAL ALCON, PHINICIA MARIBEL
Entity Type:Individual
Prefix:
First Name:PHINICIA
Middle Name:MARIBEL
Last Name:MADRIGAL ALCON
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 1:5201 W VIRGINIA AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85035-1929
Mailing Address - Country:US
Mailing Address - Phone:602-881-9849
Mailing Address - Fax:
Practice Address - Street 1:530 E MCDOWELL RD STE 107-495
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-1549
Practice Address - Country:US
Practice Address - Phone:602-726-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-22
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRBT-21-186759106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician