Healthcare Provider Details

I. General information

NPI: 1740771575
Provider Name (Legal Business Name): JAVIER ENRIQUE LAGUILLO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2018
Last Update Date: 05/29/2018
Certification Date:
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: 520-874-4800
  • Fax: 520-874-4801
Mailing address:
  • Phone: 520-874-4800
  • Fax: 520-874-4801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR76897
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: