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General NPI Number Information
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NPI Number | 1427786722
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Entity Type | Organization
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Legal Business Name | MOONSTRUCK HOLDINGS PLLC
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Dates
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Enumeration Date | 08/13/2022
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Last Update Date | 08/13/2022
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Provider Practice Location Address
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Address Line | 1745 E SKYLINE DR STE 175
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City | TUCSON
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State | AZ
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Zip | 85718-1163
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Country | US
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Telephone | 520-203-1480
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Fax |
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Provider Business Mailing Address
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Address Line | 10043 N ALDER SPRING DR
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City | TUCSON
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State | AZ
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Zip | 85737-8592
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Country | US
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Telephone | 520-270-8639
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ANNETTE MONTERROSA
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Credential | MD
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Telephone | 520-270-8639
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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