Provider Demographics
NPI:1174636005
Name:LONGORIA, ANA MARIA TERESA (MD)
Entity Type:Individual
Prefix:
First Name:ANA MARIA
Middle Name:TERESA
Last Name:LONGORIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TERSA
Other - Middle Name:
Other - Last Name:LONGOIRA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3501 E SPEEDWAY BLVD STE 300
Mailing Address - Street 2:SUITE 4
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85716-3928
Mailing Address - Country:US
Mailing Address - Phone:520-833-5171
Mailing Address - Fax:520-318-7107
Practice Address - Street 1:630 N ALVERNON WAY
Practice Address - Street 2:STE. 251
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-1843
Practice Address - Country:US
Practice Address - Phone:520-322-8460
Practice Address - Fax:520-323-5742
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ18725208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ289779Medicaid
AZ78731Medicare ID - Type Unspecified
AZ289779Medicaid