Healthcare Provider Details

I. General information

NPI: 1528224904
Provider Name (Legal Business Name): RLC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2008
Last Update Date: 01/31/2025
Certification Date: 01/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6567 E CARONDELET DR SUITE 105
TUCSON AZ
85710-2156
US

IV. Provider business mailing address

677 N WILMOT RD
TUCSON AZ
85711-2701
US

V. Phone/Fax

Practice location:
  • Phone: 520-751-3096
  • Fax: 520-901-6630
Mailing address:
  • Phone: 520-795-2889
  • Fax: 520-795-6321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State

VIII. Authorized Official

Name: KATRINA ROELLE
Title or Position: DIRECTOR OF CREDENTIALING
Credential:
Phone: 614-689-1691