Provider Demographics
NPI:1083818793
Name:LASAO, ZENDA P (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:ZENDA
Middle Name:P
Last Name:LASAO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2451 E. BASELINE RD.
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-2487
Mailing Address - Country:US
Mailing Address - Phone:480-507-2199
Mailing Address - Fax:480-507-0677
Practice Address - Street 1:2451 E. BASELINE RD.
Practice Address - Street 2:SUITE 200
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2487
Practice Address - Country:US
Practice Address - Phone:480-507-2199
Practice Address - Fax:480-507-2218
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-14
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3629363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant