Provider Demographics
NPI:1386421063
Name:SEGRERA-GRABANIA, MARILEY M
Entity type:Individual
Prefix:
First Name:MARILEY
Middle Name:M
Last Name:SEGRERA-GRABANIA
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:PO BOX 838
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85299-0838
Mailing Address - Country:US
Mailing Address - Phone:480-497-5933
Mailing Address - Fax:480-497-5934
Practice Address - Street 1:3048 E BASELINE RD STE 122
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-7288
Practice Address - Country:US
Practice Address - Phone:480-497-5933
Practice Address - Fax:480-497-5934
Is Sole Proprietor?:No
Enumeration Date:2023-09-14
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744R1102XOther Service ProvidersSpecialistResearch Study