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General NPI Number Information
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NPI Number | 1790662476
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Entity Type | Organization
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Legal Business Name | TUCSON INTEGRATIVE ACUPUNCTURE PLLC
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Dates
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Enumeration Date | 08/16/2025
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Last Update Date | 08/16/2025
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Provider Practice Location Address
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Address Line | 204 W GRANT RD UNIT 110
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City | TUCSON
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State | AZ
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Zip | 85705-5507
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Country | US
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Telephone | 520-273-2588
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Fax | 480-436-5339
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Provider Business Mailing Address
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Address Line | 1414 W CALLE PLATINO
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City | TUCSON
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State | AZ
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Zip | 85745-2778
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Country | US
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Telephone | 520-273-2588
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Fax | 480-436-5339
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. JEROME THOMAS ROBERGE JR.
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Credential | LAC
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Telephone | 520-273-2588
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | 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 | 171100000X
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Taxonomy Name | Acupuncturist
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License Number |
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License Number State |
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