Provider Demographics
NPI:1982971305
Name:SCHULTZ, LORALE (CSFA)
Entity type:Individual
Prefix:MRS
First Name:LORALE
Middle Name:
Last Name:SCHULTZ
Suffix:
Gender:F
Credentials:CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22424 S ELLSWORTH LOOP RD UNIT 937
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-7120
Mailing Address - Country:US
Mailing Address - Phone:480-370-0939
Mailing Address - Fax:
Practice Address - Street 1:5400 W ENCANTO PASEO
Practice Address - Street 2:
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85144-3260
Practice Address - Country:US
Practice Address - Phone:480-370-0939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-30
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ130372246ZC0007X
363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant