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General NPI Number Information
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NPI Number | 1346869211
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Entity Type | Individual
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Provider Name | DANIELLE MARIE-TIGER LARA PA-C
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Gender | Female
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Dates
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Enumeration Date | 04/10/2020
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Last Update Date | 10/30/2023
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Provider Practice Location Address
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Address Line | 3885 S VAL VISTA DR
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City | GILBERT
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State | AZ
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Zip | 85297-7313
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Country | US
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Telephone | 480-331-4316
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Fax | 480-571-3613
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Provider Business Mailing Address
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Address Line | 2390 W RAY RD STE 1
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City | CHANDLER
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State | AZ
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Zip | 85224-3570
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Country | US
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Telephone | 480-331-4316
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 8245
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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