Healthcare Provider Details

I. General information

NPI: 1285685669
Provider Name (Legal Business Name): JOSE M PISCOYA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1962 E. JUAN SANCHEZ BULEVARD SUITE #1
SAN LUIS AZ
85349
US

IV. Provider business mailing address

PO BOX 1986
SAN LUIS AZ
85349-1986
US

V. Phone/Fax

Practice location:
  • Phone: 928-722-6098
  • Fax: 928-627-0007
Mailing address:
  • Phone: 928-722-6098
  • Fax: 928-627-0007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number25569
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: