Provider Demographics
NPI:1134374358
Name:RAYHONS, VENECIA L (PA)
Entity type:Individual
Prefix:
First Name:VENECIA
Middle Name:L
Last Name:RAYHONS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:VENECIA
Other - Middle Name:L
Other - Last Name:RHODES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:10450 E RIGGS RD STE 114
Mailing Address - Street 2:
Mailing Address - City:SUN LAKES
Mailing Address - State:AZ
Mailing Address - Zip Code:85248-7760
Mailing Address - Country:US
Mailing Address - Phone:480-505-2450
Mailing Address - Fax:480-505-2465
Practice Address - Street 1:10450 E RIGGS RD STE 114
Practice Address - Street 2:
Practice Address - City:SUN LAKES
Practice Address - State:AZ
Practice Address - Zip Code:85248-7760
Practice Address - Country:US
Practice Address - Phone:480-505-2450
Practice Address - Fax:480-505-2465
Is Sole Proprietor?:No
Enumeration Date:2008-12-02
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4292363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ134172Medicare PIN