Healthcare Provider Details

I. General information

NPI: 1407584501
Provider Name (Legal Business Name): FAITH LOGA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2022
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13760 N 93RD AVE STE 101
PEORIA AZ
85381-4203
US

IV. Provider business mailing address

3260 N HAYDEN RD STE 112
SCOTTSDALE AZ
85251-6650
US

V. Phone/Fax

Practice location:
  • Phone: 623-547-2600
  • Fax: 623-547-1899
Mailing address:
  • Phone: 602-264-9100
  • Fax: 602-264-9101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10053
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: