Provider Demographics
NPI:1558318295
Name:ROGGIERO, ALFONSO E (PA-C)
Entity type:Individual
Prefix:
First Name:ALFONSO
Middle Name:E
Last Name:ROGGIERO
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11045 N 19TH AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-4816
Mailing Address - Country:US
Mailing Address - Phone:602-944-4474
Mailing Address - Fax:602-944-0194
Practice Address - Street 1:11045 N 19TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-4816
Practice Address - Country:US
Practice Address - Phone:602-944-4474
Practice Address - Fax:602-943-7829
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1368363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ341793Medicaid
AZZ74186Medicare PIN
AZ341793Medicaid