Provider Demographics
NPI:1427454800
Name:FRAUSTO, LUZ ANABELLE (PA)
Entity type:Individual
Prefix:
First Name:LUZ
Middle Name:ANABELLE
Last Name:FRAUSTO
Suffix:
Gender:F
Credentials:PA
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Other - First Name:
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Mailing Address - Street 1:4545 E. SOUTHERN AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-2677
Mailing Address - Country:US
Mailing Address - Phone:480-981-6100
Mailing Address - Fax:480-981-5501
Practice Address - Street 1:4545 E. SOUTHERN AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-2677
Practice Address - Country:US
Practice Address - Phone:480-981-6100
Practice Address - Fax:480-981-5501
Is Sole Proprietor?:No
Enumeration Date:2014-11-12
Last Update Date:2024-03-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA51848363A00000X
AZ9039363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant