Provider Demographics
NPI:1922341908
Name:ALCAZ, MADISON D
Entity Type:Individual
Prefix:MRS
First Name:MADISON
Middle Name:D
Last Name:ALCAZ
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 1:667 W CALLE TOLMO
Mailing Address - Street 2:
Mailing Address - City:SAHUARITA
Mailing Address - State:AZ
Mailing Address - Zip Code:85629-7820
Mailing Address - Country:US
Mailing Address - Phone:520-270-8253
Mailing Address - Fax:
Practice Address - Street 1:5855 E BROADWAY BLVD
Practice Address - Street 2:SUITE 100, STUDIO 10
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-3906
Practice Address - Country:US
Practice Address - Phone:520-270-8253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-28
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3024988174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist