Healthcare Provider Details

I. General information

NPI: 1720438088
Provider Name (Legal Business Name): DEBORAH L MALONE LAC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2016
Last Update Date: 06/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

639 E SPEEDWAY BLVD
TUCSON AZ
85705-7433
US

IV. Provider business mailing address

3120 N TERRELL PL
TUCSON AZ
85716-1525
US

V. Phone/Fax

Practice location:
  • Phone: 520-471-7808
  • Fax: 520-319-9712
Mailing address:
  • Phone: 520-471-7808
  • Fax: 520-319-9712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number0086
License Number StateAZ

VIII. Authorized Official

Name: DEBORAH LYNN MALONE
Title or Position: LICENSED ACUPUNCTURIST
Credential: LAC
Phone: 520-471-7808