Provider Demographics
NPI:1124496088
Name:JIAOCMA, MARY
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:JIAOCMA
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 1:533 W GUADALUPE RD UNIT 1067
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-7761
Mailing Address - Country:US
Mailing Address - Phone:218-230-4251
Mailing Address - Fax:
Practice Address - Street 1:533 W GUADALUPE RD UNIT 1067
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-7761
Practice Address - Country:US
Practice Address - Phone:218-230-4251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-09
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ114992279G1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2279G1100XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredGeneral Care