MEDICARE: MARJORIE ELAINE MCGINNIS COTA

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	174400000X	Specialist	4816	AZ

General Provider Information

NPI Number	:	1730551482
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARJORIE ELAINE MCGINNIS COTA

Provider Business Mailing Address
First Line	:	1601 N TUCSON BLVD STE 6
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85716-3404
Country	:	US
Telephone Number	:	520-829-9635
Fax Number	:	520-829-9636

Provider Business Practice Location Address
First Line	:	1601 N TUCSON BLVD STE 6
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85716-3404
Country	:	US
Telephone Number	:	520-829-9635
Fax Number	:	520-829-9636

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/21/2015
Last Update Date	:	10/21/2015

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