Healthcare Provider Details

I. General information

NPI: 1306307459
Provider Name (Legal Business Name): DALIA G LARIOS CHAVEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DALIA G LARIOS

II. Dates (important events)

Enumeration Date: 03/29/2019
Last Update Date: 08/21/2024
Certification Date: 08/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2946 E BANNER GATEWAY DR
GILBERT AZ
85234-2165
US

IV. Provider business mailing address

2946 E BANNER GATEWAY DR
GILBERT AZ
85234-2165
US

V. Phone/Fax

Practice location:
  • Phone: 480-256-6444
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number74147
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: