Individual
MARA DANIELLE IMMEDIATO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1255 W RIO SALADO PKWY STE 107, TEMPE, AZ 85281-2892
(480) 962-0071
(480) 962-0590
Mailing address
1255 W RIO SALADO PKWY STE 107, TEMPE, AZ 85281-2892
(480) 962-0071
(480) 962-0590
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
5195
AZ
Other
Enumeration date
09/24/2012
Last updated
02/04/2019
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