Healthcare Provider Details

I. General information

NPI: 1942614920
Provider Name (Legal Business Name): PARKINSON WELLNESS CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2014
Last Update Date: 04/22/2024
Certification Date: 04/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 N PANTANO RD STE 114
TUCSON AZ
85715-3759
US

IV. Provider business mailing address

2500 N PANTANO RD STE 114
TUCSON AZ
85715-3759
US

V. Phone/Fax

Practice location:
  • Phone: 520-780-8748
  • Fax: 520-333-3048
Mailing address:
  • Phone: 520-780-8748
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number41359
License Number StateAZ

VIII. Authorized Official

Name: CYNTHIA S REED
Title or Position: MANAGING OWNER
Credential: MD
Phone: 520-780-8748