Prince Mabiala

Primary specialty

Private VehicleTaxonomy code 347C00000X

License

ATN9038 Issued in AZ

Practice address

2575 N Country Club Rd Apt A4
Tucson, AZ 85716-2501

Phone

(520) 808-3775

Fax

(520) 748-2355

NPI assigned

Apr 4, 2012

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1333497600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1333497600000",
    "number": "1124384045",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2575 N COUNTRY CLUB RD APT A4",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857162501",
            "telephone_number": "520-808-3775",
            "fax_number": "520-748-2355"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2575 N COUNTRY CLUB RD APT A4",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857162501",
            "telephone_number": "520-808-3775",
            "fax_number": "520-748-2355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MABIALA",
        "first_name": "PRINCE",
        "name_prefix": "Mr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-04-04",
        "last_updated": "2012-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "343900000X",
            "taxonomy_group": "",
            "desc": "Non-emergency Medical Transport (VAN)",
            "state": "AZ",
            "license": null,
            "primary": false
        },
        {
            "code": "347C00000X",
            "taxonomy_group": "",
            "desc": "Private Vehicle",
            "state": "AZ",
            "license": "ATN9038",
            "primary": true
        },
        {
            "code": "347C00000X",
            "taxonomy_group": "",
            "desc": "Private Vehicle",
            "state": "AZ",
            "license": "APF8708",
            "primary": false
        },
        {
            "code": "347C00000X",
            "taxonomy_group": "",
            "desc": "Private Vehicle",
            "state": "AZ",
            "license": "AVF9340",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robert Lystrup, MD
• Morgan William Lyttle, M.D.
• M.K. Lynn Otr/L, L.L.C.
• Melody Maarouf, MD
• Julia Maberry, PHARMD
• Jennifer Mabry
• Triston Mabry
• Kathryn Elizabeth Macadangdang, LPC
• Melissa Macaluso, CRT
• Marci Macaraeg, MD

• Private Vehicle in Tucson, AZ
• Providers in Tucson, AZ by specialty
• Private Vehicle in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.