Healthcare Provider Details

I. General information

NPI: 1881982940
Provider Name (Legal Business Name): SARA MARIE JIRON P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2011
Last Update Date: 08/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4365 E PECOS RD STE 134
GILBERT AZ
85295-7875
US

IV. Provider business mailing address

4365 E PECOS RD STE 134
GILBERT AZ
85295-7875
US

V. Phone/Fax

Practice location:
  • Phone: 480-840-9155
  • Fax: 480-840-9321
Mailing address:
  • Phone: 480-840-9155
  • Fax: 480-840-9321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number4867
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: