Healthcare Provider Details

I. General information

NPI: 1215720719
Provider Name (Legal Business Name): ALEXANDER GIACOMO VAN MORREN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2025
Last Update Date: 05/27/2025
Certification Date: 05/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 N CAMPBELL AVE
TUCSON AZ
85719-4330
US

IV. Provider business mailing address

1501 N CAMPBELL AVE
TUCSON AZ
85724-0001
US

V. Phone/Fax

Practice location:
  • Phone: 520-694-0111
  • Fax:
Mailing address:
  • Phone: 520-626-5595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberR4544
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: