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General NPI Number Information
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NPI Number | 1033275938
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Entity Type | Organization
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Legal Business Name | ACACIA FAMILY MEDICINE, PC
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Dates
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Enumeration Date | 12/28/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3801 N CAMPBELL AVE SUITE B
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City | TUCSON
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State | AZ
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Zip | 85719-1448
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Country | US
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Telephone | 520-732-3361
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Fax | 520-323-3618
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Provider Business Mailing Address
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Address Line | PO BOX 43130
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City | TUCSON
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State | AZ
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Zip | 85733-3130
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Country | US
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Telephone | 520-722-3777
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Fax | 520-296-6224
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Authorized Official
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Title or Position | OWNER
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Name | SHANTI R MARTINEZ-AKSAMIT
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Credential | MD
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Telephone | 520-323-3617
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 25298
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License Number State | AZ
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