Healthcare Provider Details

I. General information

NPI: 1265704613
Provider Name (Legal Business Name): KRISTEN ASHLEY LAZARINI MPAS, PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTEN ASHLEY CARGILL

II. Dates (important events)

Enumeration Date: 02/01/2012
Last Update Date: 02/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14044 W CAMELBACK RD STE 126
LITCHFIELD PARK AZ
85340-9492
US

IV. Provider business mailing address

14044 W CAMELBACK RD STE 126
LITCHFIELD PARK AZ
85340-9492
US

V. Phone/Fax

Practice location:
  • Phone: 623-935-9600
  • Fax: 623-935-9602
Mailing address:
  • Phone: 623-935-9600
  • Fax: 623-935-9602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA07715
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5683
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: