Healthcare Provider Details

I. General information

NPI: 1992779326
Provider Name (Legal Business Name): COPPERSTATE OB-GYN ASSOCIATES, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 09/28/2022
Certification Date: 09/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5550 E HAMPTON ST
TUCSON AZ
85712
US

IV. Provider business mailing address

5550 E HAMPTON ST
TUCSON AZ
85712
US

V. Phone/Fax

Practice location:
  • Phone: 520-721-8605
  • Fax: 520-721-4209
Mailing address:
  • Phone: 520-721-8605
  • Fax: 520-721-4209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: KATHERINE FARIAS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 520-721-8605