Provider Demographics
NPI:1306237342
Name:TOMA, VIVIAN (PA-C)
Entity type:Individual
Prefix:
First Name:VIVIAN
Middle Name:
Last Name:TOMA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:VIVIAN
Other - Middle Name:
Other - Last Name:HAJI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:9059 W LAKE PLEASANT PKWY STE E540
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382
Mailing Address - Country:US
Mailing Address - Phone:520-519-7775
Mailing Address - Fax:520-519-7910
Practice Address - Street 1:9059 W LAKE PLEASANT PKWY STE E540
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382
Practice Address - Country:US
Practice Address - Phone:602-264-0608
Practice Address - Fax:602-234-0417
Is Sole Proprietor?:No
Enumeration Date:2015-02-12
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5969363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant