Individual
MR. MARK CHARLES DE LA LAMA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
4660 W THOMAS RD, PHOENIX, AZ 85031-3718
(602) 442-4500
(602) 442-4505
Mailing address
6550 N 40TH DR, PHOENIX, AZ 85019-1206
(623) 322-5842
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
3073
AZ
Other
Enumeration date
01/20/2006
Last updated
07/08/2007
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