MEDICARE: UNIVERSITY OF ARIZONARISE-RSSI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency	CSA12ADHS0204	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1679826291
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSITY OF ARIZONARISE-RSSI

Provider Business Mailing Address
First Line	:	1030 N ALVERNON WAY
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85711-1020
Country	:	US
Telephone Number	:	520-621-1642
Fax Number	:	520-626-7833

Provider Business Practice Location Address
First Line	:	1030 N ALVERNON WAY
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85711-1020
Country	:	US
Telephone Number	:	520-621-1642
Fax Number	:	520-626-7833

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	RANDA M KUTOB
Credential	:	MD
Telephone Number	:	520-621-1642

Provider Enumeration Date	:	10/19/2012
Last Update Date	:	04/17/2026

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