Provider Demographics
NPI:1487471546
Name:MARANA, MYLEN
Entity type:Individual
Prefix:
First Name:MYLEN
Middle Name:
Last Name:MARANA
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 1:12440 N 20TH ST APT 206
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85022-5888
Mailing Address - Country:US
Mailing Address - Phone:480-434-7465
Mailing Address - Fax:
Practice Address - Street 1:12440 N 20TH ST APT 206
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85022-5888
Practice Address - Country:US
Practice Address - Phone:480-434-7465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-20
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
376J00000X, 385HR2055X, 385HR2060X, 385HR2065X, 385H00000X
AZ11451878132472R0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
No376J00000XNursing Service Related ProvidersHomemaker
No385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child
No2472R0900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherRenal Dialysis
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
No385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child