Healthcare Provider Details

I. General information

NPI: 1548189574
Provider Name (Legal Business Name): TARANNOM POURJAFAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 N KOLB RD APT 16105
TUCSON AZ
85750-6180
US

IV. Provider business mailing address

4700 N KOLB RD APT 16105
TUCSON AZ
85750-6180
US

V. Phone/Fax

Practice location:
  • Phone: 520-305-8161
  • Fax:
Mailing address:
  • Phone: 520-305-8161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171R00000X
TaxonomyInterpreter
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: