Healthcare Provider Details

I. General information

NPI: 1972644532
Provider Name (Legal Business Name): TANA FRUMENTO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 12/08/2023
Certification Date: 12/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 E MCDOWELL RD STE 150
PHOENIX AZ
85008-7725
US

IV. Provider business mailing address

4801 E MCDOWELL RD STE 150
PHOENIX AZ
85008-7725
US

V. Phone/Fax

Practice location:
  • Phone: 602-954-3919
  • Fax: 602-954-3919
Mailing address:
  • Phone: 602-954-3919
  • Fax: 602-954-3670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number3540
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3540
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: