Healthcare Provider Details

I. General information

NPI: 1184178774
Provider Name (Legal Business Name): RYAN DRZEWIECKI PSYD, LP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2016
Last Update Date: 01/31/2022
Certification Date: 01/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39580 S LAGO DEL ORO PKWY
TUCSON AZ
85739-1091
US

IV. Provider business mailing address

10384 N FAIR MOUNTAIN DR
TUCSON AZ
85737-9058
US

V. Phone/Fax

Practice location:
  • Phone: 602-334-9904
  • Fax:
Mailing address:
  • Phone: 602-334-9904
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number4738
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: