Provider Demographics
NPI:1952722423
Name:GAXIOLA, ARTEMISA (LMT)
Entity Type:Individual
Prefix:
First Name:ARTEMISA
Middle Name:
Last Name:GAXIOLA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 N WILMOT RD STE 103
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-2626
Mailing Address - Country:US
Mailing Address - Phone:520-551-3497
Mailing Address - Fax:
Practice Address - Street 1:310 N WILMOT RD STE 103
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-2626
Practice Address - Country:US
Practice Address - Phone:520-551-3497
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-30
Last Update Date:2013-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-09641225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist