Healthcare Provider Details

I. General information

NPI: 1124208269
Provider Name (Legal Business Name): SAGUARO SURGICAL, P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2007
Last Update Date: 03/02/2022
Certification Date: 03/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6422 E SPEEDWAY BLVD STE 150
TUCSON AZ
85710-1149
US

IV. Provider business mailing address

6422 E SPEEDWAY BLVD STE 150
TUCSON AZ
85710-1148
US

V. Phone/Fax

Practice location:
  • Phone: 520-318-3004
  • Fax: 520-318-3061
Mailing address:
  • Phone: 520-318-3004
  • Fax: 520-318-3061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number20041
License Number StateAZ

VIII. Authorized Official

Name: ALBA CALDERON
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 520-318-3004