Provider Demographics
NPI:1477868396
Name:PASCUA YAQUI TRIBE
Entity Type:Organization
Organization Name:PASCUA YAQUI TRIBE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE HEALTH DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:REUBEN
Authorized Official - Middle Name:T
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-879-6019
Mailing Address - Street 1:7490 S CAMINO DE OESTE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85746-9308
Mailing Address - Country:US
Mailing Address - Phone:520-879-6000
Mailing Address - Fax:520-879-6099
Practice Address - Street 1:7490 S CAMINO DE OESTE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85746-9308
Practice Address - Country:US
Practice Address - Phone:520-879-6000
Practice Address - Fax:520-879-6099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-16
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZNONE 638 FACILITY261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center