Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 52125 | AZ |
N | 2080P0207X | Pediatric Hematology-Oncologist | 52155 | AZ |
NPI | 1255779385 |
---|---|
Provider Name | Michelina Calin De La Maza |
First Address | Tucson, AZ 85719 |
Second Address | Tucson, AZ 85719 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2013 |
Last Update Date | 09/10/2019 |