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General NPI Number Information
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NPI Number | 1336598655
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Entity Type | Individual
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Provider Name | KATRINA LACY D.O.
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Gender | Female
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Dates
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Enumeration Date | 06/07/2016
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Last Update Date | 04/25/2024
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Provider Practice Location Address
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Address Line | 3601 S 6TH AVE
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City | TUCSON
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State | AZ
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Zip | 85723-2102
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Country | US
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Telephone | 36-283-8742
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Fax |
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Provider Business Mailing Address
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Address Line | 3601 S 6TH AVE
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City | TUCSON
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State | AZ
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Zip | 85723-0001
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Country | US
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Telephone | 520-629-4809
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Fax | 520-783-4458
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 0102204957
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License Number State | VA
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