Provider Demographics
NPI:1508815267
Name:ARMIJO, MICHELLE A (PA)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:A
Last Name:ARMIJO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:A
Other - Last Name:POLLACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3400 N DYSART RD
Mailing Address - Street 2:STE H131
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85392-1003
Mailing Address - Country:US
Mailing Address - Phone:623-535-9777
Mailing Address - Fax:623-236-3179
Practice Address - Street 1:3400 N DYSART RD
Practice Address - Street 2:STE H131
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392-1003
Practice Address - Country:US
Practice Address - Phone:623-535-9777
Practice Address - Fax:623-236-3179
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2013-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2501207X00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ795958Medicaid
Z78726Medicare PIN
AZ795958Medicaid