Healthcare Provider Details

I. General information

NPI: 1497746127
Provider Name (Legal Business Name): TUCSON CENTRAL PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 N ALVERNON WAY SUITE 171
TUCSON AZ
85711-1843
US

IV. Provider business mailing address

630 N ALVERNON WAY SUITE 171
TUCSON AZ
85711-1843
US

V. Phone/Fax

Practice location:
  • Phone: 520-325-8000
  • Fax: 520-325-8616
Mailing address:
  • Phone: 520-325-8000
  • Fax: 520-325-8616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number23315
License Number StateAZ

VIII. Authorized Official

Name: DR. ROBERT S. HOM
Title or Position: PRESIDENT
Credential: M.D.
Phone: 520-325-8000