Healthcare Provider Details

I. General information

NPI: 1396039798
Provider Name (Legal Business Name): SYERRA N LEA DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2011
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

63 N GREENFIELD RD STE 108
MESA AZ
85205-7863
US

IV. Provider business mailing address

63 N GREENFIELD RD STE 108
MESA AZ
85205-7863
US

V. Phone/Fax

Practice location:
  • Phone: 480-470-2859
  • Fax:
Mailing address:
  • Phone: 602-671-2826
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR1899
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: