MEDICARE: DANIELLE LEIGH BOOTH PA-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	8026	AZ

General Provider Information

NPI Number	:	1780247429
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIELLE LEIGH BOOTH PA-C

Provider Business Mailing Address
First Line	:	7797 W PARADISE LN
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85382-5009
Country	:	US
Telephone Number	:	623-547-7502
Fax Number	:

Provider Business Practice Location Address
First Line	:	1743 E CAMELBACK RD STE A3
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85016-4015
Country	:	US
Telephone Number	:	602-325-5114
Fax Number	:

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

Provider Enumeration Date	:	04/18/2019
Last Update Date	:	06/02/2022

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Directions to “ DANIELLE LEIGH BOOTH PA-C” Practice Location

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