Provider Demographics
NPI:1669656161
Name:TAMAYO, ROSA
Entity Type:Individual
Prefix:MRS
First Name:ROSA
Middle Name:
Last Name:TAMAYO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2520 W RUTHANN DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85713-3040
Mailing Address - Country:US
Mailing Address - Phone:520-623-9167
Mailing Address - Fax:
Practice Address - Street 1:2520 W RUTHANN DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85713-3040
Practice Address - Country:US
Practice Address - Phone:520-623-9167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-20
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ112213747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider