Healthcare Provider Details

I. General information

NPI: 1366361826
Provider Name (Legal Business Name): EL RIO SANTA CRUZ NEIGHBORHOOD HEALTH CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CLINIC RD
GRAND CANYON AZ
86023-0290
US

IV. Provider business mailing address

450 W PASEO REDONDO
TUCSON AZ
85701-8274
US

V. Phone/Fax

Practice location:
  • Phone: 928-233-5125
  • Fax: 928-635-2181
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MELVA A GONZALEZ
Title or Position: PHARMACY COORDINATOR
Credential:
Phone: 520-670-3813