Healthcare Provider Details

I. General information

NPI: 1215974951
Provider Name (Legal Business Name): CARONDELET MEDICAL GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 02/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1209 W. TARGET RANGE RD.
NOGALES AZ
85621
US

IV. Provider business mailing address

2202 N. FORBES BLVD.
TUCSON AZ
85745
US

V. Phone/Fax

Practice location:
  • Phone: 520-287-4747
  • Fax: 520-285-3135
Mailing address:
  • Phone: 520-872-7536
  • Fax: 520-872-7929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. DEB S MOHESKY
Title or Position: EVP/CFO
Credential:
Phone: 520-872-7745