Provider Demographics
NPI:1770710782
Name:AMINI, MONA (MD)
Entity type:Individual
Prefix:
First Name:MONA
Middle Name:
Last Name:AMINI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 N 1ST ST FL 7
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004-2357
Mailing Address - Country:US
Mailing Address - Phone:602-704-2345
Mailing Address - Fax:602-704-2399
Practice Address - Street 1:7600 N 15TH ST STE 100
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-4330
Practice Address - Country:US
Practice Address - Phone:602-704-2345
Practice Address - Fax:602-704-2399
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-17
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZR715292084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ832044Medicaid
Z173154Medicare PIN