MEDICARE: EDITH LUZ LEGUIZAMO PMHNP

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	273165	AZ

General Provider Information

NPI Number	:	1881330439
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDITH LUZ LEGUIZAMO PMHNP

Provider Business Mailing Address
First Line	:	6677 W THUNDERBIRD RD STE I164
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85306-3762
Country	:	US
Telephone Number	:	623-878-2100
Fax Number	:	623-776-9419

Provider Business Practice Location Address
First Line	:	3875 N 1ST AVE
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85719-1301
Country	:	US
Telephone Number	:	520-225-0584
Fax Number	:

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

Provider Enumeration Date	:	05/06/2022
Last Update Date	:	01/31/2026

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