Healthcare Provider Details

I. General information

NPI: 1457922783
Provider Name (Legal Business Name): PETRA ROSA MOJICA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2021
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16701 N ORACLE RD STE 135
TUCSON AZ
85739-9102
US

IV. Provider business mailing address

PO BOX 188
MARANA AZ
85653-0188
US

V. Phone/Fax

Practice location:
  • Phone: 520-825-6763
  • Fax: 520-825-6841
Mailing address:
  • Phone: 520-682-4111
  • Fax: 520-616-1442

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF0621181
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number280587
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF06211981
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: