Provider Demographics
NPI:1336354380
Name:MRIZEK, VIRGINIA EVELYN (MD)
Entity Type:Individual
Prefix:DR
First Name:VIRGINIA
Middle Name:EVELYN
Last Name:MRIZEK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:GINNY
Other - Middle Name:
Other - Last Name:MRIZEK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:5981 E AVENIDA ARRIBA
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85750-1871
Mailing Address - Country:US
Mailing Address - Phone:520-615-3421
Mailing Address - Fax:
Practice Address - Street 1:5981 E AVENIDA ARRIBA
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85750-1871
Practice Address - Country:US
Practice Address - Phone:520-615-3421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ25147207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine