Healthcare Provider Details

I. General information

NPI: 1538238621
Provider Name (Legal Business Name): COMPASS VIDA LIBRE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2950 N DODGE BLVD
TUCSON AZ
85716-2012
US

IV. Provider business mailing address

2475 N JACKRABBIT AVE
TUCSON AZ
85745-1208
US

V. Phone/Fax

Practice location:
  • Phone: 520-624-5272
  • Fax:
Mailing address:
  • Phone: 520-882-5608
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code284300000X
TaxonomySpecial Hospital
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIA O'NEILL
Title or Position: INTERIM CEO
Credential:
Phone: 520-882-5608