Basic Information
| Provider Information | |||||||||
| NPI: | 1033275938 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ACACIA FAMILY MEDICINE, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 43130 | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857333130 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5207223777 | ||||||||
| FaxNumber: | 5202966224 | ||||||||
| Practice Location | |||||||||
| Address1: | 3801 N CAMPBELL AVE | ||||||||
| Address2: | SUITE B | ||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857191448 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5207323361 | ||||||||
| FaxNumber: | 5203233618 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/28/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | MARTINEZ-AKSAMIT | ||||||||
| AuthorizedOfficialFirstName: | SHANTI | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5203233617 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | 25298 | AZ | Y | Ambulatory Health Care Facilities | Clinic/Center |
No ID Information.