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General NPI Number Information
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NPI Number | 1831759240
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Entity Type | Organization
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Legal Business Name | THE UNIVERSITY OF ARIZONA
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Dates
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Enumeration Date | 06/18/2019
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Last Update Date | 06/18/2019
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Provider Practice Location Address
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Address Line | 1335 N CHERRY AVE
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City | TUCSON
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State | AZ
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Zip | 85721-0105
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Country | US
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Telephone | 520-626-2982
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Fax | 520-626-2525
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Provider Business Mailing Address
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Address Line | 1335 N CHERRY AVE
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City | TUCSON
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State | AZ
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Zip | 85721-0105
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Country | US
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Telephone | 520-626-2982
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Fax | 520-626-2525
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Authorized Official
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Title or Position | PROGRAM COORDINATOR
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Name | ANNA GASTELUM
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Credential |
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Telephone | 520-626-2982
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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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 | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number |
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License Number State |
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