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General NPI Number Information
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NPI Number | 1457800302
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Entity Type | Individual
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Provider Name | JUNIPER DERY-CHAFFIN PA-C
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Gender | Female
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Dates
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Enumeration Date | 10/03/2016
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Last Update Date | 11/21/2024
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Provider Practice Location Address
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Address Line | 1515 E OSBORN RD
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City | PHOENIX
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State | AZ
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Zip | 85014-5309
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Country | US
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Telephone | 602-604-0000
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Fax |
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Provider Business Mailing Address
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Address Line | 1241 W KNOX PL
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City | TUCSON
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State | AZ
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Zip | 85705-2505
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Country | US
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Telephone | 520-465-7259
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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 | 6500
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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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Taxonomy #3
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 6500
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License Number State | AZ
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