Healthcare Provider Details

I. General information

NPI: 1457859431
Provider Name (Legal Business Name): ALYSE JENNA MOSES-LEBRON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2018
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 N CENTRAL AVE STE 460
PHOENIX AZ
85012-1995
US

IV. Provider business mailing address

3800 NORTH CENTRAL AVENUE SUITE 460
PHOENIX AZ
85012
US

V. Phone/Fax

Practice location:
  • Phone: 310-248-4050
  • Fax:
Mailing address:
  • Phone: 310-248-4050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: