Healthcare Provider Details

I. General information

NPI: 1790662476
Provider Name (Legal Business Name): TUCSON INTEGRATIVE ACUPUNCTURE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2025
Last Update Date: 08/16/2025
Certification Date: 07/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 W GRANT RD UNIT 110
TUCSON AZ
85705-5507
US

IV. Provider business mailing address

1414 W CALLE PLATINO
TUCSON AZ
85745-2778
US

V. Phone/Fax

Practice location:
  • Phone: 520-273-2588
  • Fax: 480-436-5339
Mailing address:
  • Phone: 520-273-2588
  • Fax: 480-436-5339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. JEROME THOMAS ROBERGE JR.
Title or Position: DIRECTOR
Credential: LAC
Phone: 520-273-2588