MEDICARE: ALISA DIGGS-GOODING PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1744P3200X	Prosthetics Case Management
2	171400000X	Health & Wellness Coach
3	174H00000X	Health Educator
4	363A00000X	Physician Assistant	1864	AZ
5	332B00000X	Durable Medical Equipment & Medical Supplies

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043299373
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALISA DIGGS-GOODING PA

Provider Business Mailing Address
First Line	:	3324 E RAY RD UNIT 1057
Second Line	:
City	:	HIGLEY
State	:	AZ
Zip	:	85236-4550
Country	:	US
Telephone Number	:	602-620-6659
Fax Number	:

Provider Business Practice Location Address
First Line	:	3324 E RAY RD UNIT 1057
Second Line	:
City	:	HIGLEY
State	:	AZ
Zip	:	85236-4550
Country	:	US
Telephone Number	:	602-620-6659
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/13/2006
Last Update Date	:	10/06/2025

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