Healthcare Provider Details

I. General information

NPI: 1245355247
Provider Name (Legal Business Name): CATALINA PEDIATRICS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3085 N SWAN RD
TUCSON AZ
85712-1259
US

IV. Provider business mailing address

3085 N SWAN RD
TUCSON AZ
85712-1259
US

V. Phone/Fax

Practice location:
  • Phone: 520-323-3099
  • Fax: 520-323-3460
Mailing address:
  • Phone: 520-323-3099
  • Fax: 520-323-3460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0139138
License Number StateAZ

VIII. Authorized Official

Name: MRS. DIANE VEGALEVEY
Title or Position: PRACTICE MANAGER
Credential:
Phone: 520-323-3099