Healthcare Provider Details

I. General information

NPI: 1124397278
Provider Name (Legal Business Name): LORENA A CONDE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2011
Last Update Date: 05/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2727 W BASELINE RD SUITE 8
TEMPE AZ
85283-1067
US

IV. Provider business mailing address

2727 W BASELINE RD SUITE 8
TEMPE AZ
85283-1067
US

V. Phone/Fax

Practice location:
  • Phone: 602-323-0904
  • Fax: 602-243-7616
Mailing address:
  • Phone: 602-323-0904
  • Fax: 602-243-7616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number4992
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: