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General NPI Number Information
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NPI Number | 1538459599
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Entity Type | Individual
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Provider Name | LEIANA LUTZ JAGOLINO PA
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Gender | Female
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Dates
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Enumeration Date | 04/12/2011
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Last Update Date | 02/23/2025
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Provider Practice Location Address
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Address Line | 9700 N 91ST ST STE C200
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City | SCOTTSDALE
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State | AZ
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Zip | 85258-5064
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Country | US
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Telephone | 480-425-5078
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Fax |
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Provider Business Mailing Address
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Address Line | 2925 RYAN DR SE
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City | SALEM
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State | OR
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Zip | 97301-9687
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Country | US
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Telephone | 503-399-1262
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Fax | 503-371-0777
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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 | 006077
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA167677
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License Number State | OR
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