Provider Demographics
NPI:1508840794
Name:PERRIAN, LIANA M (PAC)
Entity Type:Individual
Prefix:
First Name:LIANA
Middle Name:M
Last Name:PERRIAN
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6365 E TANQUE VERDE RD #120
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85715-3848
Mailing Address - Country:US
Mailing Address - Phone:520-290-0300
Mailing Address - Fax:520-298-9730
Practice Address - Street 1:6365 E TANQUE VERDE RD #120
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85715-3848
Practice Address - Country:US
Practice Address - Phone:520-290-0300
Practice Address - Fax:520-298-9730
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1605363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
S80875Medicare UPIN
104352Medicare ID - Type Unspecified