Healthcare Provider Details

I. General information

NPI: 1598826588
Provider Name (Legal Business Name): LENORE SANDRA ENCINAS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 06/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 S HAMILTON ST
CHANDLER AZ
85225-6308
US

IV. Provider business mailing address

14613 S 34TH PLACE
PHOENIX AZ
85044
US

V. Phone/Fax

Practice location:
  • Phone: 480-344-6100
  • Fax:
Mailing address:
  • Phone: 520-444-3862
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number32703
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: