Healthcare Provider Details

I. General information

NPI: 1477975647
Provider Name (Legal Business Name): KEYSTONE MEDICAL, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2014
Last Update Date: 02/11/2025
Certification Date: 02/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6211 N LA CHOLLA BLVD
TUCSON AZ
85741-3528
US

IV. Provider business mailing address

PO BOX 43100
TUCSON AZ
85733-3100
US

V. Phone/Fax

Practice location:
  • Phone: 520-575-0900
  • Fax: 520-547-2382
Mailing address:
  • Phone: 520-722-3777
  • Fax: 520-547-2382

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number32180
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number32180
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number32180
License Number StateAZ

VIII. Authorized Official

Name: REBECCA PRADHAN-NARA
Title or Position: SOLE MEMBER
Credential: MD
Phone: 520-266-4338