Healthcare Provider Details

I. General information

NPI: 1043242332
Provider Name (Legal Business Name): MELISANDE HOROWITZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VERGONA GRIFFITTHSKIG

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 N 1ST AVE
TUCSON AZ
85719-2513
US

IV. Provider business mailing address

127 S 5TH AVE
TUCSON AZ
85701-2005
US

V. Phone/Fax

Practice location:
  • Phone: 520-327-4505
  • Fax: 520-202-1889
Mailing address:
  • Phone: 520-327-4505
  • Fax: 520-202-1889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN100993
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: