Erica Lalo
Individual provider Active NPI Other Technician · Polacca, AZ
NPI 1184096786 · NPPES record last updated Oct 22, 2015
Key facts
- NPI
- 1184096786
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Other Technician 247200000X
- License
- 877928 (AZ)
- Practice address
- Hwy 264 Mp388
Polacca, AZ 86042 - Phone
- (928) 737-6000
- NPI assigned
- Oct 22, 2015
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 877928 | AZ | MD | Other Technician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Other Technician | 247200000X | 877928 | AZ | Yes |
Addresses
Primary practice location
Hwy 264 Mp388
Polacca, AZ 86042
Mailing address
Hwy 264 Mp388
Polacca, AZ 86042
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 020529 | Medicaid | AZ |
Other providers in Polacca, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 22, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.