MEDICARE: CLARA LE

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	363A00000X	Physician Assistant	10379	AZ

General Provider Information

NPI Number	:	1356184964
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLARA LE

Provider Business Mailing Address
First Line	:	10240 N 43RD AVE STE 3
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85302-2044
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10240 N 43RD AVE STE 3
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85302-2044
Country	:	US
Telephone Number	:	623-742-2060
Fax Number	:

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

Provider Enumeration Date	:	06/13/2024
Last Update Date	:	06/13/2024

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Directions to “ CLARA LE ” Practice Location

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