Provider Demographics
NPI:1154925568
Name:PRUNEAN, MIHAELA
Entity type:Individual
Prefix:
First Name:MIHAELA
Middle Name:
Last Name:PRUNEAN
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 1:6403 W SANDRA TER
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-1625
Mailing Address - Country:US
Mailing Address - Phone:623-882-6545
Mailing Address - Fax:623-537-4010
Practice Address - Street 1:6403 W SANDRA TER
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-1625
Practice Address - Country:US
Practice Address - Phone:623-882-6545
Practice Address - Fax:623-537-4010
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-25
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
311ZA0620X
AZAL11643H310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home