Individual
SUSAN PASSALAQUA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2946 E BANNER GATEWAY DR., GILBERT, AZ 85234
(480) 256-6444
(480) 256-4683
Mailing address
2940 E BANNER GATEWAY DR. STE 450, GILBERT, AZ 85234
(480) 425-5063
(480) 425-5010
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
32391
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
843880
—
AZ
Enumeration date
10/21/2005
Last updated
01/21/2015
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