Healthcare Provider Details

I. General information

NPI: 1992815450
Provider Name (Legal Business Name): DIANA HOULE P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 09/18/2024
Certification Date: 09/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16430 W YUMA RD
GOODYEAR AZ
85338-3102
US

IV. Provider business mailing address

16947 W CAMBRIDGE AVE
GOODYEAR AZ
85395-1926
US

V. Phone/Fax

Practice location:
  • Phone: 623-465-6405
  • Fax:
Mailing address:
  • Phone: 623-215-8140
  • Fax: 757-490-9401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number7813
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: