Provider Demographics
NPI:1780943696
Name:DR. GANN'S DIET OF HOPE LLC
Entity type:Organization
Organization Name:DR. GANN'S DIET OF HOPE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:
Authorized Official - First Name:LETTY
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-696-3438
Mailing Address - Street 1:50 E CROYDON PARK RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-5792
Mailing Address - Country:US
Mailing Address - Phone:520-696-3438
Mailing Address - Fax:520-888-2347
Practice Address - Street 1:50 E CROYDON PARK RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-5792
Practice Address - Country:US
Practice Address - Phone:520-696-3438
Practice Address - Fax:520-888-2347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-11
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty