Basic Information
| Provider Information | |||||||||
| NPI: | 1225042666 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FALLS | ||||||||
| FirstName: | ALICIA | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1741 E MORTEN AVE STE C | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850204645 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6028700194 | ||||||||
| FaxNumber: | 6023313101 | ||||||||
| Practice Location | |||||||||
| Address1: | 1010 N COUNTRY CLUB DR | ||||||||
| Address2: | BANNER MESA MEDICAL CENTER | ||||||||
| City: | MESA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852013309 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4808341211 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/29/2006 | ||||||||
| LastUpdateDate: | 07/14/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/14/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | 363A00000X | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.