Healthcare Provider Details

I. General information

NPI: 1780677492
Provider Name (Legal Business Name): MIREILLE C ALGAZI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2005
Last Update Date: 02/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3190 N SWAN RD
TUCSON AZ
85712-1227
US

IV. Provider business mailing address

5055 E BROADWAY BLVD A100
TUCSON AZ
85711-3640
US

V. Phone/Fax

Practice location:
  • Phone: 520-547-9700
  • Fax: 520-547-9719
Mailing address:
  • Phone: 520-327-0460
  • Fax: 520-795-0225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number26221
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number26221
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: