Individual
DR. LORRI JAN CERVA-BUCHOLZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
19636 N 27TH AVENUE, SUITE 106, PHOENIX, AZ 85027
(623) 516-8252
(623) 516-8253
Mailing address
5281 N 99TH AVE, SUITE 100, GLENDALE, AZ 85305-3105
(623) 516-8252
(623) 516-8253
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
4313
AZ
2084N0400X
Neurology Physician
4313
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4313
STATE LICENSE
AZ
05
—
974528
—
AZ
Enumeration date
09/30/2006
Last updated
07/24/2014
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