Provider Demographics
NPI:1073706263
Name:UNIVERSITY OF ARIZONA
Entity Type:Organization
Organization Name:UNIVERSITY OF ARIZONA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-ORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BREITLOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-626-2761
Mailing Address - Street 1:405 E PRINCE RD
Mailing Address - Street 2:APT 611
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85705-6150
Mailing Address - Country:US
Mailing Address - Phone:520-820-9537
Mailing Address - Fax:
Practice Address - Street 1:1501 N CAMPBELL AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85724-0001
Practice Address - Country:US
Practice Address - Phone:520-626-2761
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-22
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ207R00000X.282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital