Healthcare Provider Details

I. General information

NPI: 1952505141
Provider Name (Legal Business Name): LEA MARCIE ALHILALI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2007
Last Update Date: 10/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 W THOMAS RD
PHOENIX AZ
85013-4409
US

IV. Provider business mailing address

PO BOX 44037
PHOENIX AZ
85064-4037
US

V. Phone/Fax

Practice location:
  • Phone: 602-954-6228
  • Fax: 602-957-6142
Mailing address:
  • Phone: 602-954-6882
  • Fax: 602-975-6142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License NumberMD441656
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD441656
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number42074
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: