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General NPI Number Information
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NPI Number | 1730041336
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Entity Type | Individual
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Provider Name | LYDIANE PAMBOUD
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Gender | Female
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Dates
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Enumeration Date | 12/02/2025
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Last Update Date | 12/02/2025
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Provider Practice Location Address
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Address Line | 2048 S MCCONNELL DR
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City | TUCSON
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State | AZ
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Zip | 85710-8088
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Country | US
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Telephone | 520-257-9744
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Fax |
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Provider Business Mailing Address
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Address Line | 4000 N CENTRAL AVE STE 100
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City | PHOENIX
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State | AZ
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Zip | 85012-3520
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Country | US
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Telephone | 602-708-0240
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number | ADBH20008
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number | ADBH20008
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License Number State | AZ
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