Healthcare Provider Details

I. General information

NPI: 1184911257
Provider Name (Legal Business Name): COLLABORATIVE ASSOCIATES IN SURGICAL ASSISTING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2011
Last Update Date: 06/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5601 E. CAMINO DEL CELADOR
TUCSON AZ
85750
US

IV. Provider business mailing address

5601 E. CAMINO DEL CELADOR
TUCSON AZ
85750
US

V. Phone/Fax

Practice location:
  • Phone: 520-303-4780
  • Fax:
Mailing address:
  • Phone: 520-979-9178
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN139696
License Number StateAZ

VIII. Authorized Official

Name: MR. JEREMY ERREN GOFTON
Title or Position: CEO
Credential: RNFA
Phone: 520-979-9178