Healthcare Provider Details

I. General information

NPI: 1376483297
Provider Name (Legal Business Name): ALEJANDRO CONCHA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 89742
TUCSON AZ
85752-9742
US

IV. Provider business mailing address

PO BOX 89742
TUCSON AZ
85752-9742
US

V. Phone/Fax

Practice location:
  • Phone: 520-261-0452
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number260341
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: