Healthcare Provider Details

I. General information

NPI: 1982971305
Provider Name (Legal Business Name): LORALE SCHULTZ CSFA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2011
Last Update Date: 09/20/2024
Certification Date: 09/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5400 W ENCANTO PASEO
QUEEN CREEK AZ
85144-3260
US

IV. Provider business mailing address

22424 S ELLSWORTH LOOP RD UNIT 937
QUEEN CREEK AZ
85142-7120
US

V. Phone/Fax

Practice location:
  • Phone: 480-370-0939
  • Fax:
Mailing address:
  • Phone: 480-370-0939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number130372
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: