Provider Demographics
NPI:1184828469
Name:LA PAZ COUNTY HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:LA PAZ COUNTY HEALTH DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF NURSING
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:L
Authorized Official - Last Name:GRAZIER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:928-669-1100
Mailing Address - Street 1:1112 S JOSHUA AVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:PARKER
Mailing Address - State:AZ
Mailing Address - Zip Code:85344-5755
Mailing Address - Country:US
Mailing Address - Phone:928-669-1100
Mailing Address - Fax:
Practice Address - Street 1:1112 S JOSHUA AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:PARKER
Practice Address - State:AZ
Practice Address - Zip Code:85344-5755
Practice Address - Country:US
Practice Address - Phone:928-669-1100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTC0744261QP0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZS92177Medicare UPIN