Provider Demographics
NPI:1407849458
Name:FALTA, BARBRA (PA-C)
Entity Type:Individual
Prefix:
First Name:BARBRA
Middle Name:
Last Name:FALTA
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 1:4350 N 19TH AVE
Mailing Address - Street 2:SUITE #6
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85015-4602
Mailing Address - Country:US
Mailing Address - Phone:602-264-9191
Mailing Address - Fax:602-532-2973
Practice Address - Street 1:4350 N 19TH AVE
Practice Address - Street 2:SUITE #6
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-4602
Practice Address - Country:US
Practice Address - Phone:602-264-9191
Practice Address - Fax:602-532-2973
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ1920363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
S22194Medicare UPIN