Healthcare Provider Details

I. General information

NPI: 1740802065
Provider Name (Legal Business Name): NITISHA LOTUN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2020
Last Update Date: 09/18/2024
Certification Date: 08/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 N CAMPBELL AVE RM 4401
TUCSON AZ
85724-1443
US

IV. Provider business mailing address

3731 E CALLE DEL CACTO
TUCSON AZ
85718-3341
US

V. Phone/Fax

Practice location:
  • Phone: 520-626-7221
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number73169
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: