Healthcare Provider Details

I. General information

NPI: 1083818793
Provider Name (Legal Business Name): ZENDA P LASAO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2007
Last Update Date: 11/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2451 E. BASELINE RD. SUITE 200
GILBERT AZ
85234-2487
US

IV. Provider business mailing address

2451 E. BASELINE RD. SUITE 200
GILBERT AZ
85234-2487
US

V. Phone/Fax

Practice location:
  • Phone: 480-507-2199
  • Fax: 480-507-2218
Mailing address:
  • Phone: 480-507-2199
  • Fax: 480-507-0677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3629
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: