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General NPI Number Information
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NPI Number | 1750672929
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Entity Type | Organization
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Legal Business Name | EL RIO SANTA CRUZ NEIGHBORHOOD HEALTH CENTER, INC
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Dates
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Enumeration Date | 04/22/2011
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Last Update Date | 05/28/2025
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Provider Practice Location Address
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Address Line | 1500 W COMMERCE CT BLDG 01, 02
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City | TUCSON
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State | AZ
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Zip | 85746-6015
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Country | US
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Telephone | 520-806-2650
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1231
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City | TUCSON
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State | AZ
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Zip | 85702-1231
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Country | US
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Telephone | 520-670-3909
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | CLINTON KUNTZ
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Credential |
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Telephone | 520-309-2012
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number | OTC0788
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License Number State | AZ
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