Active NPI
Tera Crisalida, PA
- Physician Assistant
- Tempe, AZ
National Provider Identifier
1720167950
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 3834
- Practice address
- 1006 E Guadalupe Rd
Tempe, AZ 85283-3047 - Phone
- (480) 838-4296
- Fax
- (480) 820-1275
- NPI assigned
- Nov 6, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA-530 | ID | |
| Physician Assistant | 363A00000X | 3834 | AZ | Primary |
Addresses
Primary practice location
1006 E Guadalupe Rd
Tempe, AZ 85283-3047
Mailing address
3055 N Red MTN Unit 220
Mesa, AZ 85207-1059
Phone (208) 201-5111
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 341903 | Medicaid | AZ |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA-530 | ID | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162771200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1278979200000",
"number": "1720167950",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3055 N RED MTN UNIT 220",
"city": "MESA",
"state": "AZ",
"postal_code": "852071059",
"telephone_number": "208-201-5111"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1006 E GUADALUPE RD",
"city": "TEMPE",
"state": "AZ",
"postal_code": "852833047",
"telephone_number": "480-838-4296",
"fax_number": "480-820-1275"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CRISALIDA",
"first_name": "TERA",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-11-06",
"last_updated": "2010-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "ID",
"license": "PA-530",
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "AZ",
"license": "3834",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "341903",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tempe, AZ
- Creosote Total Health PC
- Briana Crespo
- Crestview Child Counseling, LLC
- Crestview Pharmacy Services LLC
- Kourtney Crier, PSY.D.
- Crisis Preparation and Recovery, Inc
- Crisis Preparation and Recovery, Inc
- Crisis Preparation and Recovery, Inc
- Crisis Preparation and Recovery, Inc.
- Crisis Preparation and Recovery, Inc.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.