Healthcare Provider Details

I. General information

NPI: 1427037753
Provider Name (Legal Business Name): CATHERINE M COSENTINO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2006
Last Update Date: 08/18/2021
Certification Date: 08/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5166 E GLENN ST
TUCSON AZ
85712-1337
US

IV. Provider business mailing address

PO BOX 31235
TUCSON AZ
85751-1235
US

V. Phone/Fax

Practice location:
  • Phone: 520-795-5338
  • Fax: 520-795-5382
Mailing address:
  • Phone: 520-324-2308
  • Fax: 520-324-1406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number20291
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License Number20291
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: