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General NPI Number Information
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NPI Number | 1821808650
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Entity Type | Organization
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Legal Business Name | PLACITA MOBILE PRIMARY, LLC
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Dates
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Enumeration Date | 01/13/2025
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Last Update Date | 01/15/2025
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Provider Practice Location Address
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Address Line | 6303 E TANQUE VERDE RD STE 311
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City | TUCSON
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State | AZ
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Zip | 85715-3857
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Country | US
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Telephone | 520-904-4274
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Fax |
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Provider Business Mailing Address
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Address Line | 333 N WILMOT RD STE 340
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City | TUCSON
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State | AZ
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Zip | 85711-2607
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Country | US
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Telephone | 520-904-4274
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | KEITH CONDON
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Credential |
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Telephone | 520-904-4274
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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