Provider Demographics
NPI:1225042666
Name:FALLS, ALICIA (PA-C)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:FALLS
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 1:1741 E MORTEN AVE STE C
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-4645
Mailing Address - Country:US
Mailing Address - Phone:602-870-0194
Mailing Address - Fax:602-331-3101
Practice Address - Street 1:1010 N COUNTRY CLUB DR
Practice Address - Street 2:BANNER MESA MEDICAL CENTER
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201-3309
Practice Address - Country:US
Practice Address - Phone:480-834-1211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZP89478Medicare UPIN