Individual
LIZETTE LEACH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1852 N MASTICK WAY, NOGALES, AZ 85621-1063
(520) 281-1550
(520) 281-1112
Mailing address
825 N GRAND AVE STE 100, NOGALES, AZ 85621-1061
(520) 281-1550
(520) 281-1112
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
363A00000X
Physician Assistant
7306
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
482965
—
AZ
01
—
7306
ARIZONA REGULATORY BOARD OF PHYSICIAN ASSISTANTS
AZ
Enumeration date
09/24/2018
Last updated
03/21/2023
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