Healthcare Provider Details

I. General information

NPI: 1114751476
Provider Name (Legal Business Name): PASCUA YAQUI TRIBE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2024
Last Update Date: 05/14/2025
Certification Date: 05/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7490 S CAMINO DE OESTE TUCSON, AZ 85746
TUCSON AZ
85746
US

IV. Provider business mailing address

7490 S CAMINO DE OESTE
TUCSON AZ
85746-9308
US

V. Phone/Fax

Practice location:
  • Phone: 520-879-6039
  • Fax:
Mailing address:
  • Phone: 520-879-6039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LINDA GUERRERO
Title or Position: DELEGATED OFFICIAL
Credential:
Phone: 520-879-6039