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General NPI Number Information
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NPI Number | 1568943561
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Entity Type | Organization
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Legal Business Name | SANTA CRUZ VALLEY PHYSICIAN GROUP LLC
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Dates
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Enumeration Date | 08/27/2018
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Last Update Date | 04/14/2020
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Provider Practice Location Address
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Address Line | 4455 S I 19 FRONTAGE RD
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City | GREEN VALLEY
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State | AZ
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Zip | 85614-5884
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Country | US
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Telephone | 520-393-4700
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Fax | 520-393-4923
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Provider Business Mailing Address
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Address Line | 4455 S I 19 FRONTAGE RD
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City | GREEN VALLEY
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State | AZ
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Zip | 85614-5884
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Country | US
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Telephone | 520-393-4700
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Fax | 520-393-4923
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Authorized Official
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Title or Position | HEALTH PLAN RELATIONS
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Name | ZAMIA MOSMAN
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Credential |
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Telephone | 520-405-9687
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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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