Provider Demographics
NPI:1346598596
Name:SONORAN EYE CARE AND AESTHETICS INC
Entity Type:Organization
Organization Name:SONORAN EYE CARE AND AESTHETICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SOOFIA
Authorized Official - Middle Name:
Authorized Official - Last Name:RUBBANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-638-5553
Mailing Address - Street 1:400 W MAGEE RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-6438
Mailing Address - Country:US
Mailing Address - Phone:520-623-5553
Mailing Address - Fax:520-638-5543
Practice Address - Street 1:400 W MAGEE RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-6438
Practice Address - Country:US
Practice Address - Phone:520-623-5553
Practice Address - Fax:520-638-5543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-20
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ726166Medicaid