DataLabs
datalabs.health made in the usa
DataLabs Facebook Wall   Like   Follow DataLabs on Twitter   Tweet  
Contact us Sign in |  Documentation | 
NPI Code Detail

MEDICARE: MARISA J PUTRASAHAN PA

MEDICARE: MARISA J PUTRASAHAN PA
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
1363A00000XPhysician Assistant

General Provider Information

NPI Number : 1669303780
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARISA J PUTRASAHAN PA
Provider Business Mailing Address
First Line : 2108 E THOMAS RD STE 130
Second Line :
City : PHOENIX
State : AZ
Zip : 85016-0008
Country : US
Telephone Number : 602-933-3124
Fax Number :
Provider Business Practice Location Address
First Line : 1919 E THOMAS RD
Second Line :
City : PHOENIX
State : AZ
Zip : 85016-7710
Country : US
Telephone Number : 602-933-2728
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/27/2026
Last Update Date : 05/27/2026

Similar Medicare Providers

1700453644 — DANIELLE BONSER
Practice Location Address:
1919 E THOMAS RD
PHOENIX, AZ
85016-7710
Practice Phone: 602-933-0945
Practice Fax:
1336776061 — DR. SAMUEL KAMOROFF MD
Practice Location Address:
1919 E THOMAS RD
PHOENIX, AZ
85016-7710
Practice Phone: 602-933-1000
Practice Fax:
1861275018 — NICOLE ZAND PHARMD, RPH
Practice Location Address:
1919 E THOMAS RD
PHOENIX, AZ
85016-7710
Practice Phone: 602-933-2048
Practice Fax:
1376922708 — JAMIE MARIE FLEMING MD
Practice Location Address:
1919 E THOMAS RD
PHOENIX, AZ
85016-7710
Practice Phone: 602-933-7246
Practice Fax: 602-933-4341
1831543396 — ADAM FARMER
Practice Location Address:
1919 E THOMAS RD , PHOENIX CHILDREN'S HOSPITAL
PHOENIX, AZ
85016-7710
Practice Phone: 602-546-2923
Practice Fax:
1417211921 — DR. SEAN JAMES GAMBLE M.D.
Practice Location Address:
1919 E THOMAS RD
PHOENIX, AZ
85016-7710
Practice Phone: 602-933-7246
Practice Fax: 602-933-4341

Directions to “ MARISA J PUTRASAHAN PA” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.