Healthcare Provider Details

I. General information

NPI: 1659202570
Provider Name (Legal Business Name): SAMANTHA IRENE OLSSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3950 S COUNTRY CLUB RD STE 130
TUCSON AZ
85714-2203
US

IV. Provider business mailing address

3950 S COUNTRY CLUB RD STE 130
TUCSON AZ
85714-2203
US

V. Phone/Fax

Practice location:
  • Phone: 520-670-3909
  • Fax: 520-309-2560
Mailing address:
  • Phone: 520-670-3909
  • Fax: 520-309-2560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR82780
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: