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General NPI Number Information
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NPI Number | 1578516555
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Entity Type | Organization
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Legal Business Name | COCHISE EAR NOSE AND THROAT ASSOCIATES PLLC
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Dates
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Enumeration Date | 05/18/2006
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Last Update Date | 10/06/2014
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Provider Practice Location Address
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Address Line | 155 CALLE PORTAL SUITE 600
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City | SIERRA VISTA
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State | AZ
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Zip | 85635-2900
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Country | US
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Telephone | 520-458-4919
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 93
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City | SIERRA VISTA
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State | AZ
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Zip | 85636-0093
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Country | US
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Telephone | 520-458-4919
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | LAWRENCE NUNEZ TERUEL
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Credential | M.D
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Telephone | 520-458-4919
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 34998
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License Number State | AZ
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