Healthcare Provider Details

I. General information

NPI: 1437266749
Provider Name (Legal Business Name): CYNTHIA E REARDON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 07/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 S 6TH AVE
TUCSON AZ
85723-0001
US

IV. Provider business mailing address

6408 E TANQUE VERDE RD
TUCSON AZ
85715-3809
US

V. Phone/Fax

Practice location:
  • Phone: 520-792-1450
  • Fax:
Mailing address:
  • Phone: 520-885-5558
  • Fax: 520-885-5559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD00023678
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: