Healthcare Provider Details

I. General information

NPI: 1518200641
Provider Name (Legal Business Name): MARY J PICCHIONI PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2013
Last Update Date: 05/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N EL DORADO PL SUITE I-905
TUCSON AZ
85715-4637
US

IV. Provider business mailing address

1200 N EL DORADO PL SUITE I-905
TUCSON AZ
85715-4637
US

V. Phone/Fax

Practice location:
  • Phone: 520-954-2551
  • Fax: 520-344-8871
Mailing address:
  • Phone: 520-954-2551
  • Fax: 520-344-8871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberDN005040
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: