Healthcare Provider Details

I. General information

NPI: 1154629343
Provider Name (Legal Business Name): THOMAS GIAMMARINO PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2011
Last Update Date: 02/04/2021
Certification Date: 02/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9250 N 3RD ST SUITE #3000
PHOENIX AZ
85020-2437
US

IV. Provider business mailing address

9250 N 3RD ST SUITE #3000
PHOENIX AZ
85020-2437
US

V. Phone/Fax

Practice location:
  • Phone: 602-266-2272
  • Fax: 602-266-2927
Mailing address:
  • Phone: 602-266-2272
  • Fax: 602-266-2927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number4795
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: