Basic Information
| Provider Information | |||||||||
| NPI: | 1447364484 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LAFREDO | ||||||||
| FirstName: | LYANNA JOY | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | YUCHONGTIAN | ||||||||
| OtherFirstName: | LYANNA JOY | ||||||||
| OtherMiddleName: | SIA | ||||||||
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| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 3269 N STOCKTON HILL RD | ||||||||
| Address2: | |||||||||
| City: | KINGMAN | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 864093619 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9286818706 | ||||||||
| FaxNumber: | 9286818707 | ||||||||
| Practice Location | |||||||||
| Address1: | 2202 N STOCKTON HILL RD STE 100 | ||||||||
| Address2: | |||||||||
| City: | KINGMAN | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 864014622 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9286818706 | ||||||||
| FaxNumber: | 9286818707 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2006 | ||||||||
| LastUpdateDate: | 12/27/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 29421 | SC | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 42300 | AZ | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.