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General NPI Number Information
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NPI Number | 1659161222
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Entity Type | Organization
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Legal Business Name | MESQUITE MEDICAL LLC
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Dates
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Enumeration Date | 05/08/2025
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Last Update Date | 05/08/2025
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Provider Practice Location Address
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Address Line | 3910 N CAMPBELL AVE
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City | TUCSON
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State | AZ
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Zip | 85719-1428
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Country | US
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Telephone | 520-369-2463
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Fax | 706-642-4634
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Provider Business Mailing Address
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Address Line | 6095 E GRANT RD
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City | TUCSON
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State | AZ
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Zip | 85712-2343
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Country | US
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Telephone | 520-369-2463
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Fax | 706-642-4634
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Authorized Official
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Title or Position | ADMINISTRATOR/PROVIDER
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Name | MANUEL ROMO
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Credential | FNP
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Telephone | 520-369-2463
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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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