Individual
LEIANA LUTZ JAGOLINO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
9700 N 91ST ST STE C200, SCOTTSDALE, AZ 85258-5064
(480) 425-5078
Mailing address
2925 RYAN DR SE, SALEM, OR 97301-9687
(503) 399-1262
(503) 371-0777
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
006077
GA
363AM0700X
Medical Physician Assistant
Primary
PA167677
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003109002A
—
GA
05
—
2044027
—
WA
05
—
500685132
—
OR
Enumeration date
04/12/2011
Last updated
02/23/2025
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