Healthcare Provider Details

I. General information

NPI: 1821989708
Provider Name (Legal Business Name): SOUTHERN ARIZONA LIMB PRESERVATION CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2025
Last Update Date: 07/10/2025
Certification Date: 07/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6130 N LA CHOLLA BLVD STE 111
TUCSON AZ
85741-3589
US

IV. Provider business mailing address

6130 N LA CHOLLA BLVD STE 111
TUCSON AZ
85741-3589
US

V. Phone/Fax

Practice location:
  • Phone: 310-919-9560
  • Fax:
Mailing address:
  • Phone: 310-919-9560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2083P0011X
TaxonomyUndersea and Hyperbaric Medicine (Preventive Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. DIANE L BOONE
Title or Position: MANAGING MEMBER
Credential: RN MS
Phone: 310-919-9560