Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 10441 | AZ |
NPI | 1013431212 |
---|---|
Provider Name | Mr. Gabriel Leyba Altamirano |
First Address | Tucson, AZ 85710-4132 |
Second Address | Tucson, AZ 85718-6526 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2017 |
Last Update Date | 17/03/2018 |