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General NPI Number Information
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NPI Number | 1437696127
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Entity Type | Organization
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Legal Business Name | TANYA UNDERWOOD, DO, PLLC
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Dates
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Enumeration Date | 01/19/2017
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Last Update Date | 01/26/2023
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Provider Practice Location Address
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Address Line | 5800 W ARIZONA PAVILIONS DR UNIT 248
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City | CORTARO
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State | AZ
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Zip | 85652-2909
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Country | US
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Telephone | 520-638-5997
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Fax | 520-372-2552
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Provider Business Mailing Address
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Address Line | 5800 W ARIZONA PAVILIONS DR UNIT 248
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City | CORTARO
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State | AZ
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Zip | 85652-2909
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Country | US
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Telephone | 520-638-5997
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Fax | 520-372-2552
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Authorized Official
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Title or Position | CEO
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Name | TANYA UNDERWOOD
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Credential | DO
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Telephone | 520-638-5997
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 3547
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License Number State | AZ
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