Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 4106 | AZ |
Y | 103TC0700X | Clinical Psychologist | 4106 | AZ |
NPI | 1013125780 |
---|---|
Provider Name | John Tsanadis |
First Address | Oro Valley, AZ 85755-1963 |
Second Address | Oro Valley, AZ 85755-1963 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2007 |
Last Update Date | 25/03/2011 |