Healthcare Provider Details

I. General information

NPI: 1700475977
Provider Name (Legal Business Name): TUCSON PLASTIC SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2021
Last Update Date: 01/26/2023
Certification Date: 01/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5780 N SWAN RD STE 180
TUCSON AZ
85718-4527
US

IV. Provider business mailing address

5780 N SWAN RD STE 180
TUCSON AZ
85718-4527
US

V. Phone/Fax

Practice location:
  • Phone: 520-448-9490
  • Fax: 520-448-9492
Mailing address:
  • Phone: 520-448-9490
  • Fax: 520-448-9492

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2082S0099X
TaxonomyPlastic Surgery Within the Head and Neck (Plastic Surgery) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: RAMAN C MAHABIR
Title or Position: CEO
Credential: MD
Phone: 602-499-4599