Provider Demographics
NPI:1124397278
Name:CONDE, LORENA A (PA-C)
Entity Type:Individual
Prefix:
First Name:LORENA
Middle Name:A
Last Name:CONDE
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 1:2727 W BASELINE RD
Mailing Address - Street 2:SUITE 8
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-1067
Mailing Address - Country:US
Mailing Address - Phone:602-323-0904
Mailing Address - Fax:602-243-7616
Practice Address - Street 1:2727 W BASELINE RD
Practice Address - Street 2:SUITE 8
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-1067
Practice Address - Country:US
Practice Address - Phone:602-323-0904
Practice Address - Fax:602-243-7616
Is Sole Proprietor?:No
Enumeration Date:2011-12-19
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4992363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ4992OtherLICENSE