Provider Demographics
NPI:1871280008
Name:MAHGOOB, ROGIA
Entity type:Individual
Prefix:MS
First Name:ROGIA
Middle Name:
Last Name:MAHGOOB
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 1:4201 W SURREY AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-1974
Mailing Address - Country:US
Mailing Address - Phone:602-299-9204
Mailing Address - Fax:
Practice Address - Street 1:4201 W SURREY AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-1974
Practice Address - Country:US
Practice Address - Phone:602-299-9204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-19
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility