MEDICARE: LORI DIAS CPO

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	222Z00000X	Orthotist		AZ

General Provider Information

NPI Number	:	1851188494
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORI DIAS CPO

Provider Business Mailing Address
First Line	:	3816 N 7TH ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85014-5004
Country	:	US
Telephone Number	:	480-316-2195
Fax Number	:	480-316-2195

Provider Business Practice Location Address
First Line	:	3816 N 7TH ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85014-5004
Country	:	US
Telephone Number	:	480-316-2195
Fax Number	:

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

Provider Enumeration Date	:	04/24/2025
Last Update Date	:	04/24/2025

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