Healthcare Provider Details

I. General information

NPI: 1205930500
Provider Name (Legal Business Name): ORO VALLEY MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2006
Last Update Date: 02/22/2021
Certification Date: 02/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1171 E RANCHO VISTOSO BLVD STE 143
ORO VALLEY AZ
85755-9101
US

IV. Provider business mailing address

PO BOX 43160
TUCSON AZ
85733-3160
US

V. Phone/Fax

Practice location:
  • Phone: 520-399-8094
  • Fax: 888-416-1743
Mailing address:
  • Phone: 520-722-3777
  • Fax: 520-296-6224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: AKASH AHARAD TAGGARSE
Title or Position: OWNER
Credential: MD
Phone: 520-429-8523