Individual
ERICA LALO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
HWY 264 MP388, POLACCA, AZ 86042
(928) 737-6000
Mailing address
HWY 264 MP388, POLACCA, AZ 86042
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
877928
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
020529
—
AZ
Enumeration date
10/22/2015
Last updated
10/22/2015
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