Provider Demographics
NPI:1922584796
Name:NINO MOJICA, JESSICA MARIA (MD)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:MARIA
Last Name:NINO MOJICA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 E CAMELBACK RD STE 180
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-2396
Mailing Address - Country:US
Mailing Address - Phone:520-634-8888
Mailing Address - Fax:602-224-3358
Practice Address - Street 1:1704 W ANKLAM RD STE 107
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745-2656
Practice Address - Country:US
Practice Address - Phone:520-622-3569
Practice Address - Fax:520-623-7257
Is Sole Proprietor?:No
Enumeration Date:2018-07-16
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP09657207P00000X
AZR79324207RN0300X
AZ71798207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine