Healthcare Provider Details

I. General information

NPI: 1306406988
Provider Name (Legal Business Name): ANGELINA PLASS DNP, CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANGELINA LIRA DNP, CRNA

II. Dates (important events)

Enumeration Date: 06/17/2019
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20333 N 19TH AVE STE 100
PHOENIX AZ
85027-3602
US

IV. Provider business mailing address

3939 BELL RD
PHOENIX AZ
85032
US

V. Phone/Fax

Practice location:
  • Phone: 623-516-8252
  • Fax: 623-516-8253
Mailing address:
  • Phone: 602-923-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number240243
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: