Provider Demographics
NPI:1295560167
Name:CRESPO-LEZAMA, MONICA (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:CRESPO-LEZAMA
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:MS
Other - First Name:MONICA
Other - Middle Name:
Other - Last Name:CRESPO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHYSICIAN ASSISTANT
Mailing Address - Street 1:5151 N 16TH ST APT 2035
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-3811
Mailing Address - Country:US
Mailing Address - Phone:939-645-6978
Mailing Address - Fax:
Practice Address - Street 1:5151 N 16TH ST APT 2035
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-3811
Practice Address - Country:US
Practice Address - Phone:939-645-6978
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-03
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1493-PA363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant