Provider Demographics
NPI:1487751947
Name:LAX, DANIELA (MD)
Entity type:Individual
Prefix:MS
First Name:DANIELA
Middle Name:
Last Name:LAX
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 E ELVIRA RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85756-7124
Mailing Address - Country:US
Mailing Address - Phone:520-626-6508
Mailing Address - Fax:520-626-6571
Practice Address - Street 1:535 N WILMOT RD
Practice Address - Street 2:SUITE #101
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711
Practice Address - Country:US
Practice Address - Phone:520-694-9988
Practice Address - Fax:520-694-9917
Is Sole Proprietor?:No
Enumeration Date:2006-09-19
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ179362080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ280488Medicaid
06WCGCR11Medicare ID - Type Unspecified
AZ280488Medicaid