Provider Demographics
NPI:1962673574
Name:FIRST ASSIST, PC
Entity Type:Organization
Organization Name:FIRST ASSIST, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LUMINITA
Authorized Official - Middle Name:
Authorized Official - Last Name:IACOB
Authorized Official - Suffix:
Authorized Official - Credentials:PAC
Authorized Official - Phone:623-326-5464
Mailing Address - Street 1:5922 W YUCCA ST
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85304-3776
Mailing Address - Country:US
Mailing Address - Phone:623-487-5084
Mailing Address - Fax:
Practice Address - Street 1:5922 W YUCCA ST
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85304-3776
Practice Address - Country:US
Practice Address - Phone:623-487-5084
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-23
Last Update Date:2008-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZL13738154305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization