Provider Demographics
NPI:1538474374
Name:UNIVERSITY OF ARIZONA
Entity Type:Organization
Organization Name:UNIVERSITY OF ARIZONA
Other - Org Name:CAMPUS HEALTH SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:HUMAN RESOURCES REPRESENTATIVE
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-626-6903
Mailing Address - Street 1:PO BOX 210095
Mailing Address - Street 2:1224 E. LOWELL STREET, BLDG. 95
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85721-0095
Mailing Address - Country:US
Mailing Address - Phone:520-626-6903
Mailing Address - Fax:520-626-8962
Practice Address - Street 1:1224 E LOWELL ST BLDG 95
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85721-0095
Practice Address - Country:US
Practice Address - Phone:520-626-6903
Practice Address - Fax:520-626-8962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-17
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3726 - PSYCHOLOGIST261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health