Healthcare Provider Details

I. General information

NPI: 1336354380
Provider Name (Legal Business Name): VIRGINIA EVELYN MRIZEK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: GINNY MRIZEK M.D.

II. Dates (important events)

Enumeration Date: 05/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5981 E AVENIDA ARRIBA
TUCSON AZ
85750-1871
US

IV. Provider business mailing address

5981 E AVENIDA ARRIBA
TUCSON AZ
85750-1871
US

V. Phone/Fax

Practice location:
  • Phone: 520-615-3421
  • Fax:
Mailing address:
  • Phone: 520-615-3421
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25147
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: