MEDICARE: MS. TRICIA A. LATIOLAIT P.A.-C

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	11137	AZ

General Provider Information

NPI Number	:	1730487802
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TRICIA A. LATIOLAIT P.A.-C

Provider Business Mailing Address
First Line	:	15845 W ARROWHEAD DR
Second Line	:
City	:	SURPRISE
State	:	AZ
Zip	:	85374-5631
Country	:	US
Telephone Number	:	562-307-3672
Fax Number	:

Provider Business Practice Location Address
First Line	:	10180 W HAPPY VALLEY PKWY STE 100
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85383-1389
Country	:	US
Telephone Number	:	623-227-4585
Fax Number	:

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

Provider Enumeration Date	:	03/14/2011
Last Update Date	:	01/16/2026

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