=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780993600
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EL RIO SANTA CRUZ NEIGHBORHOOD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/27/2010
-----------------------------------------------------
Last Update Date | 04/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 101 W IRVINGTON RD BLDG 10
-----------------------------------------------------
City | TUCSON
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85714-3050
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 520-309-4585
-----------------------------------------------------
Fax | 520-309-4589
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1231
-----------------------------------------------------
City | TUCSON
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85702-1231
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 520-670-3813
-----------------------------------------------------
Fax | 520-670-7560
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | CLINTON G KUNTZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 520-601-0607
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0002X
-----------------------------------------------------
Taxonomy Name | Clinic Pharmacy
-----------------------------------------------------
License Number | Y005308
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------