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General NPI Number Information
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NPI Number | 1245663319
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Entity Type | Organization
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Legal Business Name | COCHISE MEDICAL ONCOLOGY, LLC
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Dates
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Enumeration Date | 08/13/2013
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Last Update Date | 10/28/2013
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Provider Practice Location Address
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Address Line | 5151 E HIGHWAY 90
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City | SIERRA VISTA
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State | AZ
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Zip | 85635-2436
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Country | US
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Telephone | 520-803-6644
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Fax |
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Provider Business Mailing Address
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Address Line | 5151 E HIGHWAY 90
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City | SIERRA VISTA
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State | AZ
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Zip | 85635-2436
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Country | US
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Telephone | 520-803-6644
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JANET NETTLETON
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Credential | M.D.
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Telephone | 520-803-6644
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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