Provider Demographics
NPI:1043510852
Name:DARBAN, JILL (LAC)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:DARBAN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12820 W FORT LOWELL RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85743-9144
Mailing Address - Country:US
Mailing Address - Phone:520-780-1230
Mailing Address - Fax:
Practice Address - Street 1:698 E WETMORE RD
Practice Address - Street 2:SUITE 420
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85705-1751
Practice Address - Country:US
Practice Address - Phone:520-780-1230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-26
Last Update Date:2015-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0597171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist