Healthcare Provider Details

I. General information

NPI: 1982946224
Provider Name (Legal Business Name): AMARANTA AMATISTA CAMPOS LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2013
Last Update Date: 03/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15920 S RANCHO SAHUARITA BLVD STE 160
SAHUARITA AZ
85629-8014
US

IV. Provider business mailing address

10020 S NOGALES HWY UNIT 6
TUCSON AZ
85756-9207
US

V. Phone/Fax

Practice location:
  • Phone: 520-867-8064
  • Fax: 520-867-8063
Mailing address:
  • Phone: 520-906-3459
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License NumberMT-15113
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: