MEDICARE: MRS. SANYA BERONJA FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	AP4735	AZ

General Provider Information

NPI Number	:	1225375868
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SANYA BERONJA FNP

Provider Business Mailing Address
First Line	:	7205 W REMUDA DR
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85383-7304
Country	:	US
Telephone Number	:	602-478-6951
Fax Number	:

Provider Business Practice Location Address
First Line	:	1635 N GREENFIELD RD
Second Line	:	SUITE 134
City	:	MESA
State	:	AZ
Zip	:	85205-4005
Country	:	US
Telephone Number	:	480-854-7123
Fax Number	:	480-854-7627

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/15/2013
Last Update Date	:	01/15/2013

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