Healthcare Provider Details

I. General information

NPI: 1396397204
Provider Name (Legal Business Name): ROUSHUN ZIBARI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2019
Last Update Date: 02/15/2022
Certification Date: 12/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 N CAMPBELL AVE
TUCSON AZ
85719-4330
US

IV. Provider business mailing address

3515 N SABINO CANYON RD APT 38
TUCSON AZ
85750-2117
US

V. Phone/Fax

Practice location:
  • Phone: 520-694-0111
  • Fax:
Mailing address:
  • Phone: 214-600-2844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number231685
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: