Healthcare Provider Details

I. General information

NPI: 1528204005
Provider Name (Legal Business Name): LAURIE A FARRICIELLI MD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2009
Last Update Date: 01/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6360 E. THOMAS RD. #218
SCOTTSDALE AZ
85251-7054
US

IV. Provider business mailing address

P.O. BOX 14406
SCOTTSDALE AZ
85267-4406
US

V. Phone/Fax

Practice location:
  • Phone: 480-860-0935
  • Fax: 480-860-6569
Mailing address:
  • Phone: 480-860-0935
  • Fax: 480-860-6569

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NI0900X
TaxonomyInternist Chiropractor
License Number21865
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number21865
License Number StateAZ

VIII. Authorized Official

Name: DR. LAURIE A FARRICIELLI
Title or Position: PRESIDENT
Credential: MD
Phone: 480-860-0935