Healthcare Provider Details

I. General information

NPI: 1932187218
Provider Name (Legal Business Name): TUCSON ORTHOPEDIC LAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2006
Last Update Date: 11/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3818 E 5TH ST
TUCSON AZ
85716-5145
US

IV. Provider business mailing address

PO BOX 43863
TUCSON AZ
85733-3863
US

V. Phone/Fax

Practice location:
  • Phone: 520-319-0339
  • Fax: 520-319-7825
Mailing address:
  • Phone: 520-319-0339
  • Fax: 520-319-7825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number StateAZ

VIII. Authorized Official

Name: DANNY CHAN
Title or Position: PRESIDENT
Credential: C.O.
Phone: 520-319-0339