MEDICARE: CATALINA PEDIATRICS, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	0139138	AZ

General Provider Information

NPI Number	:	1245355247
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CATALINA PEDIATRICS, PC

Provider Business Mailing Address
First Line	:	3085 N SWAN RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85712-1259
Country	:	US
Telephone Number	:	520-323-3099
Fax Number	:	520-323-3460

Provider Business Practice Location Address
First Line	:	3085 N SWAN RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85712-1259
Country	:	US
Telephone Number	:	520-323-3099
Fax Number	:	520-323-3460

Authorized Official
Title or Position	:	PRACTICE MANAGER
Name	:	MRS. DIANE VEGALEVEY
Credential	:
Telephone Number	:	520-323-3099

Provider Enumeration Date	:	03/20/2007
Last Update Date	:	08/22/2020

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