Crisalida, Tera

Crisalida, Tera is an individual health care provider with primary practice located at 1006 E Guadalupe Rd , Tempe AZ 85283-3047. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as her primary health care specialty. Crisalida, Tera can be contacted via phone (480) 838-4296.

Contact Information

Primary practice address
1006 E Guadalupe Rd Tempe AZ 85283-3047
Phone: (480) 838-4296
Fax: (480) 820-1275
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X PA-530 Idaho
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 3834 Arizona

Profile Details

NPI number 1720167950
LBN Legal business name Crisalida, Tera
Credentials Physician Assistant (PA)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 6th, 2006
Last updated Jul 13th, 2010 - about 16 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1720167950 NPPES
Arizona MEDICAID 341903

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