Healthcare Provider Details

I. General information

NPI: 1275696288
Provider Name (Legal Business Name): LINA KAY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LINA GULKAROVA PA-C

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 10/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4545 E CHANDLER BLVD STE 206
PHOENIX AZ
85048-7645
US

IV. Provider business mailing address

10181 N 92ND ST STE 101
SCOTTSDALE AZ
85258-4559
US

V. Phone/Fax

Practice location:
  • Phone: 480-961-5956
  • Fax: 480-598-1314
Mailing address:
  • Phone: 480-502-1158
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number2733
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: