Provider Demographics
NPI:1124488309
Name:MOGA, MIRELA LIANA (NP)
Entity type:Individual
Prefix:MRS
First Name:MIRELA
Middle Name:LIANA
Last Name:MOGA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MIRELA
Other - Middle Name:LIANA
Other - Last Name:PLATONA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16859 W TONBRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-0832
Mailing Address - Country:US
Mailing Address - Phone:623-544-1539
Mailing Address - Fax:
Practice Address - Street 1:1800 E VAN BUREN ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-3742
Practice Address - Country:US
Practice Address - Phone:602-251-8624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-01
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP8459363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health