Provider Demographics
NPI:1023197548
Name:GITIRANA, FREDERICO LEAO (DC)
Entity Type:Individual
Prefix:DR
First Name:FREDERICO
Middle Name:LEAO
Last Name:GITIRANA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15206 E MUSTANG DR
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN HILLS
Mailing Address - State:AZ
Mailing Address - Zip Code:85268-4846
Mailing Address - Country:US
Mailing Address - Phone:480-255-0252
Mailing Address - Fax:
Practice Address - Street 1:15090 N NORTHSIGHT BLVD
Practice Address - Street 2:104
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-2610
Practice Address - Country:US
Practice Address - Phone:480-368-0200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7251111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor