# CCENT & FPS

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** CCENT & FPS
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1467629469
- **Legal business name:** CCENT & FPS
- **Authorized official:** DR. TAMARAH A FRATIANNI D.O (PHYSICIAN)
- **Authorized official phone:** (928) 774-1873

## Contact information

- **Practice address:** 300 W WHITE MOUNTAIN BLVD, SUITE D, LAKESIDE, AR 85929-6533
- **Practice address phone:** (928) 774-1873
- **Mailing address:** 1340 N RIM DRIVE, FLAGSTAFF, AZ 86001-1311
- **Mailing address phone:** (928) 774-1873
- **Mailing address fax:** (928) 774-5525

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207K00000X | Allergy & Immunology Physician | 3000 | AZ | Yes |
| 207YX0905X | Otolaryngology/Facial Plastic Surgery Physician | 3000 | AZ | — |

## Other

- **Enumeration date:** 05/09/2008
- **Last updated:** 05/09/2008