Individual
NANCY DE LA VARA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
725 E. MAIN ST., SUITE 1C, SOMERTON, AZ 85350-0634
(928) 627-4525
Mailing address
PO BOX 634, SOMERTON, AZ 85350-0634
(928) 627-4525
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
2571I
AZ
Other
Enumeration date
01/03/2011
Last updated
08/14/2013
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