Provider Demographics
NPI:1942521406
Name:TWIN PEAKS FAMILY PRACTICE PC
Entity Type:Organization
Organization Name:TWIN PEAKS FAMILY PRACTICE PC
Other - Org Name:CONTINENTAL RANCH FAMILY PRACTICE PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VIVIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTILLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-297-1595
Mailing Address - Street 1:2055 W HOSPITAL DR STE 195
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-7823
Mailing Address - Country:US
Mailing Address - Phone:520-297-1595
Mailing Address - Fax:520-572-2301
Practice Address - Street 1:2055 W HOSPITAL DR STE 195
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-7823
Practice Address - Country:US
Practice Address - Phone:520-297-1595
Practice Address - Fax:520-572-2301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-18
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ139088Medicare PIN