Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | AP8143 | AZ |
NPI | 1003288945 |
---|---|
Provider Name | Mrs. Diana Verdugo |
First Address | Tucson, AZ 85701-1713 |
Second Address | Tucson, AZ 85711-1448 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/10/2015 |
Last Update Date | 29/10/2015 |