Healthcare Provider Details

I. General information

NPI: 1205699790
Provider Name (Legal Business Name): PIMA COUNTY HEALTH DEPT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2024
Last Update Date: 02/06/2024
Certification Date: 02/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 N OLD ROMERO RD
TUCSON AZ
85705-2289
US

IV. Provider business mailing address

3950 S COUNTRY CLUB RD
TUCSON AZ
85714-2099
US

V. Phone/Fax

Practice location:
  • Phone: 520-724-9545
  • Fax:
Mailing address:
  • Phone: 520-724-7742
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State

VIII. Authorized Official

Name: NIKKI L COCROFT
Title or Position: CLINICAL SERVICES COORDINATOR
Credential:
Phone: 520-724-7742