Healthcare Provider Details

I. General information

NPI: 1891293197
Provider Name (Legal Business Name): MELYNDA CICCHINI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2018
Last Update Date: 02/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 W SPEEDWAY BLVD
TUCSON AZ
85745-2326
US

IV. Provider business mailing address

7407 N MOWRY PL
TUCSON AZ
85741-2573
US

V. Phone/Fax

Practice location:
  • Phone: 520-770-3658
  • Fax:
Mailing address:
  • Phone: 928-640-7805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN199948
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: