Healthcare Provider Details

I. General information

NPI: 1023235934
Provider Name (Legal Business Name): TANYA HENRY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 05/26/2022
Certification Date: 05/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1852 N MASTICK WAY
NOGALES AZ
85621-1063
US

IV. Provider business mailing address

825 N GRAND AVE STE 100
NOGALES AZ
85621-1061
US

V. Phone/Fax

Practice location:
  • Phone: 520-281-1550
  • Fax:
Mailing address:
  • Phone: 520-761-2133
  • Fax: 520-281-1112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number45257
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: