Healthcare Provider Details

I. General information

NPI: 1124203682
Provider Name (Legal Business Name): MARILOU ERRAZO-SEARLES AD RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARILOU ERRAZO RN

II. Dates (important events)

Enumeration Date: 01/03/2008
Last Update Date: 05/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11109 E TANQUE VERDE RD
TUCSON AZ
85749
US

IV. Provider business mailing address

11109 E TANQUE VERDE RD
TUCSON AZ
85749
US

V. Phone/Fax

Practice location:
  • Phone: 520-749-3772
  • Fax: 520-749-3772
Mailing address:
  • Phone: 520-749-3772
  • Fax: 520-749-3772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN105263
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code163WC3500X
TaxonomyCardiac Rehabilitation Registered Nurse
License NumberRN105263
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License NumberALH-6273
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: