Search › Arizona › 101Y00000X
Bonny Beach, LISAC
NPI 1578999041 · on the registry since 2013
Practice
- Address
- 1648 S 16th St
Phoenix, AZ 85034 - Phone
- (602) 448-0935
- Fax
- (602) 532-7202
- Organisation at this address
- Sequoia Support Sevices
Inferred from a shared address, not stated in the registry.
- Clinicians at this address
- 2
Registry record
- Primary taxonomy
- 101Y00000X
101Y00000X
- Licence states on file
- AZ
From the registry's licence fields, which are often incomplete.
- Sex
- Female
- Record last updated
- 2013-09-17
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Arizona