Individual
JASA DEFAZIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
2175 N ALMA SCHOOL RD STE A106, CHANDLER, AZ 85224-2882
(480) 855-0474
Mailing address
7340 E LEGACY BLVD UNIT H4005, SCOTTSDALE, AZ 85255-6531
(484) 400-1342
Taxonomy
Speciality
Code
Description
License number
State
2080P0008X
Pediatric Neurodevelopmental Disabilities Physician
Primary
OTA-046588
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
946932790
UNITED HEALTH CARE
PA
Enumeration date
07/15/2018
Last updated
07/15/2018
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