OrganizationActive
Ccent & Fps
NPI 1467629469 · Allergy & Immunology Physician · Lakeside, AR
Provider details
- NPI number
- 1467629469
- Entity type
- Organization
- Primary specialty
- Allergy & Immunology PhysicianAllopathic & Osteopathic Physicians
- Parent organization
- Ccent & Fps
- Organization subpart
- Yes
- Authorized official
- Tamarah Fratianni, Physician(928) 774-1873
- License
- 3000 (AZ)
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Allopathic & Osteopathic Physicians
Practice location
300 W White Mountain Blvd
Suite D
Lakeside, AR 85929-6533
Phone: (928) 774-1873
Approximate (ZIP-level) locationGet directions
Mailing address
1340 N Rim Drive
Flagstaff, AZ 86001-1311
Registry dates
- Enumerated
- 2008-05-09
- Last updated
- 2008-05-09
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.