Provider Demographics
NPI:1659161222
Name:MESQUITE MEDICAL LLC
Entity type:Organization
Organization Name:MESQUITE MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ROMO
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:520-369-2463
Mailing Address - Street 1:6095 E GRANT RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-2343
Mailing Address - Country:US
Mailing Address - Phone:520-369-2463
Mailing Address - Fax:706-642-4634
Practice Address - Street 1:3910 N CAMPBELL AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85719-1428
Practice Address - Country:US
Practice Address - Phone:520-369-2463
Practice Address - Fax:706-642-4634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-08
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty