Provider Demographics
NPI:1760817746
Name:PUENTE NUEVO #2, LLC, DBA LA PALOMA SURGERY CENTER
Entity Type:Organization
Organization Name:PUENTE NUEVO #2, LLC, DBA LA PALOMA SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-722-6277
Mailing Address - Street 1:4041 E SUNRISE DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-4333
Mailing Address - Country:US
Mailing Address - Phone:520-722-6277
Mailing Address - Fax:
Practice Address - Street 1:4041 E SUNRISE DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85718-4333
Practice Address - Country:US
Practice Address - Phone:520-722-6277
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-09
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOSC5398261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical