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Organization
CCENT & FPS
Active
Organization
CCENT & FPS
Active
Parent organization
CCENT & FPS
Organization subpart
Yes
Provider details
NPI number
Legal business name
CCENT & FPS
Authorized official
DR. TAMARAH A FRATIANNI D.O (PHYSICIAN)
(928) 774-1873
Entity
Organization
Contact information
Practice address
300 W WHITE MOUNTAIN BLVD, SUITE D, LAKESIDE, AR 85929-6533
(928) 774-1873
Mailing address
1340 N RIM DRIVE, FLAGSTAFF, AZ 86001-1311
(928) 774-1873
(928) 774-5525
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
3000
AZ
207YX0905X
Otolaryngology/Facial Plastic Surgery Physician
3000
AZ
Other
Enumeration date
05/09/2008
Last updated
05/09/2008
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