Basic Information
| Provider Information | |||||||||
| NPI: | 1124208269 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SAGUARO SURGICAL, P C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6422 E SPEEDWAY BLVD | ||||||||
| Address2: | STE 150 | ||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857101148 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5203183004 | ||||||||
| FaxNumber: | 5203183061 | ||||||||
| Practice Location | |||||||||
| Address1: | 6422 E SPEEDWAY BLVD STE 150 | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857101149 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5203183004 | ||||||||
| FaxNumber: | 5203183061 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/06/2007 | ||||||||
| LastUpdateDate: | 03/02/2022 | ||||||||
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| AuthorizedOfficialLastName: | CALDERON | ||||||||
| AuthorizedOfficialFirstName: | ALBA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CREDENTIALING SPECIALIST | ||||||||
| AuthorizedOfficialTelephone: | 5203183004 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 03/02/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 20041 | AZ | Y | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.