Healthcare Provider Details

I. General information

NPI: 1770824203
Provider Name (Legal Business Name): TLC PEDIATRICS TUCSON, PLLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2013
Last Update Date: 03/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6620 E CARONDELET DR
TUCSON AZ
85710-2119
US

IV. Provider business mailing address

6620 E CARONDELET DR
TUCSON AZ
85710-2119
US

V. Phone/Fax

Practice location:
  • Phone: 520-296-3248
  • Fax: 520-296-3249
Mailing address:
  • Phone: 520-296-3248
  • Fax: 520-296-3249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number29512
License Number StateAZ

VIII. Authorized Official

Name: ROSA L LOPEZ-COHEN
Title or Position: PRESIDENT
Credential: MD
Phone: 520-296-3248