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General NPI Number Information
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NPI Number | 1265165484
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Entity Type | Organization
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Legal Business Name | AGAVE FAMILY MEDICINE & BREAST FEEDING SUPPORT CENTER LLC
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Dates
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Enumeration Date | 07/06/2022
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Last Update Date | 09/30/2022
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Provider Practice Location Address
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Address Line | 1925 W ORANGE GROVE RD STE 201
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City | TUCSON
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State | AZ
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Zip | 85704-1151
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Country | US
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Telephone | 520-372-2167
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Fax |
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Provider Business Mailing Address
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Address Line | 1925 W ORANGE GROVE RD STE 201
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City | TUCSON
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State | AZ
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Zip | 85704-1151
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Country | US
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Telephone | 520-372-2167
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. MARY C HARREL
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Credential | MD
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Telephone | 602-999-4659
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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