Provider Demographics
NPI:1003254897
Name:DENNIS, LISA (RPA/RA (CBRPA))
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:DENNIS
Suffix:
Gender:F
Credentials:RPA/RA (CBRPA)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 64568
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85082-4568
Mailing Address - Country:US
Mailing Address - Phone:480-421-9700
Mailing Address - Fax:
Practice Address - Street 1:1457 W SOUTHERN AVE STE 26
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-4862
Practice Address - Country:US
Practice Address - Phone:480-374-7354
Practice Address - Fax:480-371-1121
Is Sole Proprietor?:No
Enumeration Date:2013-06-13
Last Update Date:2016-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ13AZ1474243U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes243U00000XTechnologists, Technicians & Other Technical Service ProvidersRadiology Practitioner Assistant