Healthcare Provider Details

I. General information

NPI: 1760817746
Provider Name (Legal Business Name): PUENTE NUEVO #2, LLC, DBA LA PALOMA SURGERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2013
Last Update Date: 09/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4041 E SUNRISE DR
TUCSON AZ
85718-4333
US

IV. Provider business mailing address

4041 E SUNRISE DR
TUCSON AZ
85718-4333
US

V. Phone/Fax

Practice location:
  • Phone: 520-722-6277
  • Fax:
Mailing address:
  • Phone: 520-722-6277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberOSC5398
License Number StateAZ

VIII. Authorized Official

Name: DR. PATRICIA MARS
Title or Position: MANAGER
Credential: M.D.
Phone: 520-722-6277