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General NPI Number Information
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NPI Number | 1760513824
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Entity Type | Organization
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Legal Business Name | RAAD TAKI SURGERY CENTER
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Dates
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Enumeration Date | 03/08/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4580 E CAMP LOWELL DR
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City | TUCSON
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State | AZ
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Zip | 85712-1282
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Country | US
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Telephone | 520-881-3232
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Fax | 520-881-3535
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Provider Business Mailing Address
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Address Line | 4580 E CAMP LOWELL DR
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City | TUCSON
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State | AZ
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Zip | 85712-1282
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Country | US
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Telephone | 520-881-3232
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Fax | 520-881-3535
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | LYNN GROBERG
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Credential | RN
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Telephone | 520-881-3232
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | AZ 27306
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License Number State | AZ
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