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General NPI Number Information
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NPI Number | 1023461092
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Entity Type | Organization
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Legal Business Name | LASALA MEDICAL LLC
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Dates
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Enumeration Date | 07/14/2016
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Last Update Date | 02/15/2021
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Provider Practice Location Address
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Address Line | 7609 E PINNACLE PEAK RD SUITE 9
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City | SCOTTSDALE
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State | AZ
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Zip | 85255-3415
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Country | US
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Telephone | 480-267-9111
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Fax | 480-454-4897
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Provider Business Mailing Address
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Address Line | 7609 E PINNACLE PEAK RD SUITE 9
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City | SCOTTSDALE
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State | AZ
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Zip | 85255-3460
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Country | US
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Telephone | 480-267-9111
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Fax | 480-454-4897
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Authorized Official
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Title or Position | OWNER
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Name | DR. SUSAN ELAINE LASALA-WOOD
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Credential | DNP FNP-C, RNFA
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Telephone | 480-267-9111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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