Healthcare Provider Details

I. General information

NPI: 1558368787
Provider Name (Legal Business Name): ALFONSO LLANO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2005
Last Update Date: 01/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7383 E TANQUE VERDE RD
TUCSON AZ
85715-3475
US

IV. Provider business mailing address

PO BOX 43130
TUCSON AZ
85733-3130
US

V. Phone/Fax

Practice location:
  • Phone: 520-318-3434
  • Fax: 520-296-6224
Mailing address:
  • Phone: 520-722-3777
  • Fax: 520-296-6224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number0101223311
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number41384
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: